Repeat 2-Stage Revision for Recurrent Infection of Total Hip Arthroplasty

Kalra, Kunal; Lin, Kirk; Bozic, Kevin J.; Ries, Michael D.

doi:10.1016/j.arth.2009.12.010

Cited by 38 publications

(22 citation statements)

References 22 publications

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“…However, these extensive surgeries for treatment of infected revision THA will be difficult and risky to perform in patients with comorbidities and prior revision THAs. Furthermore, the likelihood of complications is higher in infected revision THA than in infected primary THA along with more extensive loss of muscular mass, bone, or both162325). Accordingly, the treatment of infected revision THA is challenging and the decision about which option to perform is very difficult for arthroplasty surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…As an alternative, less extensive surgeries such as debridement and component retention, minor partial one-stage exchange, and major partial one-stage exchange have been performed in a select group of cases, and success rates ranging from 38% to 90% have been reported to date91220212223). We performed aggressive debridement and used antibiotic-loaded cement beads with retention of the prosthesis for treating acute delayed or late infection of revision THAs, and did even in cases of reinfection after two-stage reimplantation for infected primary or revision THAs because a low success rate of 36.4% has been reported after another reimplantation, to date25). Our preliminary study shows a favorable result compared with other less extensive surgeries despite a lower success rate than with one- or two-stage reimplantation1920212223).…”

Section: Discussionmentioning

confidence: 99%

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Acute Delayed or Late Infection of Revision Total Hip Arthroplasty Treated with Debridement/Antibiotic-loaded Cement Beads and Retention of the Prosthesis

et al. 2017

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PurposeThe treatment of infected revision total hip arthroplasty (THA) is very challenging due to retained revision prosthesis, poor bone stock and soft tissue condition derived from previous revision surgeries, and comorbidities. The purpose of this study was to investigate the effectiveness and short-term outcomes of aggressive debridement and use of antibiotic-loaded cement beads with retention of the prosthesis for acute delayed or late infection of revision THAs.Materials and MethodsTen consecutive patients with symptoms or signs of less than one-week evolution and well-fixed prostheses, were treated with this procedure and a postoperative course of organism-specific antibiotics for a minimum of 6 weeks. All hips presented with acute delayed or late infection of revision THAs. Patients with a mean age of 68.1 years (range, 59-78 years) underwent an average of 1.9 previous revision THAs (1-4) before the index surgery. The minimal follow-up was 2 years with a mean of 46.2 months (range, 24-64 months).ResultsThere were 8 cures (80.0%) and 2 failures with no mortality during the study period. The 2 failures involved the same and resistant bacteria implicated in the primary infection (methicillin-resistant Staphylococcus aureus and Prevotella oralis, respectively). The mean Harris hip score was 65.2 (range, 26-83) and the mean visual analogue scale was 2.6 (range, 1-4) at final follow-up.ConclusionWith a favorable success rate and no mortality, our procedure may be considered a safe and effective alternative for the treatment of acute delayed or late infection of revision THAs with well-fixed prostheses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Delayed or Late Infection of Revision Total Hip Arthroplasty Treated with Debridement/Antibiotic-loaded Cement Beads and Retention of the Prosthesis

et al. 2017

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“…Although the incidence of PJI ranges from 0.2% to 1%34567), the PJI is a significant (or major) cause of implant failure and requires multiple operations including revision arthroplasty89). Moreover, the treatment of PJI is very difficult and recurrence is common1011). Therefore, the prevention of PJI is very important in hip arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Lower Urinary Tract Infection and Periprosthetic Joint Infection after Elective Primary Total Hip Arthroplasty

2017

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PurposePeriprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a grave complication. Urinary tract infection (UTI) as a source for PJI is controversial. Our purposes were, (1) to evaluate the incidence of PJI after elective primary THA and (2) to determine whether UTI was associated with a risk of PJI after elective primary THA.Materials and MethodsWe retrospectively reviewed the medical records of 527 patients who underwent elective primary THA by using universal aseptic technique from May 2003 to October 2007. UTI group (13 patients) was defined as patients who underwent THA in status of having an UTI, and the remaining patients were defined as control group (514 patients). We compared the incidence of PJI in both groups.ResultsDuring the study period, the incidence of PJI was 0%, regardless of existence (or presence) of UTI.ConclusionThere was no significant association between UTI and PJI, when cautiously performed THA.

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“…In their series, the infecting microorganisms were polymicrobial in 3 patients and only 2 had reinfection by the initial offending microbe (22).…”

Section: Evidence Acquisitionmentioning

confidence: 99%

“…Justification: Patients undergoing reimplantation surgery following a two-stage exchange procedure are at risk of developing recurrent infection (21,22). The recurrent infection may be either due to incomplete eradication of the prior bacteria during the antibiotic spacer exchange or to a new infection.…”

Section: Evidence Acquisitionmentioning

confidence: 99%

Optimal Timing and Antibiotic Prophylaxis in Periprosthetic Joint Infection: Literature Review and World Consensus (Part Four)

2015

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Context: There is a need to find the optimal postoperative duration and the choice of starting antibiotics for cases who presumed infected or at the time of second stage exchange arthroplasty in two-stage revision of infected cases. Evidence Acquisition: Delegates in workgroup 3 of the consensus meeting on PJI reviewed English literature for relevant articles. Sixtytwo of 221 articles were relevant to the 5 following questions regarding perioperative antibiotic prophylaxis to prevent periprosthetic joint infection. Results: Postoperative antibiotics should not be administered for greater than 24 hours after surgery. In a patient with a presumed infection when culture results are pending, empiric antibiotic coverage should depend on the local microbiological epidemiology. Culture data should assist in the tailoring of antibiotic regimens. The appropriate preoperative antibiotic for the second stage should include coverage of the prior organism (s). Cemented arthroplasty components should be inserted with antibiotic-laden bone cement (strong consensus). Conclusions: Recommendations for choice, duration of perioperative antibiotic prophylaxis in hip and knee arthroplasty were provided based on evidences in the literature and consensus of expert delegates from consensus meeting.

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Repeat 2-Stage Revision for Recurrent Infection of Total Hip Arthroplasty

Cited by 38 publications

References 22 publications

Acute Delayed or Late Infection of Revision Total Hip Arthroplasty Treated with Debridement/Antibiotic-loaded Cement Beads and Retention of the Prosthesis

Acute Delayed or Late Infection of Revision Total Hip Arthroplasty Treated with Debridement/Antibiotic-loaded Cement Beads and Retention of the Prosthesis

Lower Urinary Tract Infection and Periprosthetic Joint Infection after Elective Primary Total Hip Arthroplasty

Optimal Timing and Antibiotic Prophylaxis in Periprosthetic Joint Infection: Literature Review and World Consensus (Part Four)

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