Retention treatment after periprosthetic total hip arthroplasty infection

Abstract

Purpose The purpose of this study was to compare infection control rates between implant retention and two-stage revision and assess the effectiveness of retention treatment in THA. Methods Twenty-eight debridements with implant retention (retention group) and 65 staged revisions (removal group) were retrospectively analysed and risk factors that can contribute to failure of infection control were explored. Results For the retention and removal groups, infection control rates were 50% and 78% after initial treatment, and 68% and 82% at latest follow-up, respectively. There were no significant differences in the number of additional operative procedures, total length of hospital stay, and duration of treatment between groups. Infection of revision THA, polybacterial and S. aureus infection were identified as risk factors for infection control. Conclusions Retention treatment can be considered an initial treatment option in selected cases of primary THA, with a single organism, non-S. aureus infection with 50% chance of infection control and no disadvantages in terms of additional procedure, hospital stay, and treatment duration.

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

“…With a suspected PJI, surgical eradication of the pathogen must be combined with an effective and targeted antimicrobial therapy. Surgical options include debridement and retention in cases of acute infection, or a complete exchange of the implant in a one-step or two-step approach in cases of chronic infection [6,10,11].…”

Can periprosthetic hip joint infections be successfully managed by debridement and prosthesis retention?

“…A total of 11 studies reporting on 292 cases could be identified ( Figure 1) [2][3][6][7][8][9][10][11][12][13][14] . Two studies were published before and nine after 2000.…”

“…One study [10] reported on debridement and another on debridement and irrigation [12] . Six studies performed debridement, lavage and change of modular prosthesis components (polyethylene (PE) liner, femoral stem head) [2,3,6,7,9,14] , whereas in one of these studies the PE liner was not changed in all patients [9] . One study combined this procedure along with the use of the vacuum-assisted closure therapy [11] .…”

“…[12] 89.6% (26/29) [8,13] 92.8% (26/28) [11] 70.4% (126/179) [2,3,6,7,9,14] ing factors identified no difference between methicillinsensitive and methicillin-resistant staphylococcus or head/liner exchange and no exchange [9] . These findings are contradictory to the general acceptance that prosthesis retention is feasible at the site of early infection with a short duration of symptoms.…”

“…12 All late 2 Ⅳ Choi et al [9] 2012 28 All early 3 Ⅲ Crockarell et al [10] 1998 [11] 2009 28 All early 2 Ⅳ Klouche et al [12] 2011 12 All early 3 Ⅳ Lee et al [13] 2013 19 10 late 3 Ⅳ 9 acute hematogenous Tsukayama et al [2] 1996 41 35 early 3 Ⅳ 6 acute hematogenous Waagsbø et al [3] 2009 40 30 early 4 Ⅳ 10 late Westberg et al [14] 2013…”