Similar Risk of Re-Revision in Patients after One- or Two-Stage Surgical Revision of Infected Total Hip Arthroplasty: An Analysis of Revisions in the Swedish Hip Arthroplasty Register 1979–2015

Svensson, Karin; Rolfson, Ola; Kärrholm, Johan; Mohaddes, Maziar

doi:10.3390/jcm8040485

Cited by 30 publications

(21 citation statements)

References 25 publications

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“…Kaplan-Meier analysis did not show any difference in reinfection-free survival between polymicrobial and monomicrobial FCPHIs in this series (14 vs. 51) 1 . The reinfection-free success rates were 100% for polymicrobial PHIs and 94% (±0.03) for monomicrobial PHIs at a 2-year follow-up (log-rank, p = 0.347).…”

Section: Discussioncontrasting

confidence: 62%

“…There are currently two conventional surgical treatment procedures. The two-stage exchange arthroplasty is the most common treatment worldwide; nevertheless, a one-stage exchange procedure is gaining more and more ground ( 1 – 4 ). This technique is encouraged by satisfactory results of infection control rate in selected patients, at a minimum follow-up of 2 years [Wroblewski et al ( 5 ), 91%; Loty et al ( 6 ), 91%; Raut et al ( 7 ), 86%; Winkler et al ( 8 ), 92%; Klouche et al ( 9 ), 100%; Hansen et al ( 10 ), 70%; Choi et al ( 11 ), 82%; Zeller et al ( 12 ), 96%].…”

Section: Introductionmentioning

confidence: 99%

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One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

et al. 2020

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Background: Prosthetic hip infection (PHI) is a disastrous scenario after an arthroplasty. International guidelines contraindicate one-stage exchange arthroplasty for fistulizing chronic prosthetic hip infection (FCPHI), nevertheless few surgical teams, mostly from Europe, support one stage procedure for this indication. Questions/Purposes: Analysis of infection recurrence and implant failure of a series of FCPHIs treated with one stage arthroplasty. Patients and Methods: Sixty-six FCPHIs treated with one-stage exchange arthroplasty were prospectively followed up at least 2 years. Clinical, radiological and bacteriological signs suggestive of reinfection were sought, as well as implant failures and PHI related deaths. Results: Thirty-four females and thirty-two males with median age of 69.5 years [61-77] and BMI of 26 kg/m² [22-31] were included. Fistulae were productive in 50 patients (76%). Staphylococcus was responsible for 45% of PHI and 21% were polymicrobial. Twentynine patients (44%) received preoperative antibiotic therapy. After a median 60-month follow-up [35-82], 3 patients (4.5%) presented reinfection (two new infections, one relapse) and 3 patients experienced implant failure (1 femoral fracture, 1 stem breakage, 1 recurrent dislocation). One death was related to PHI. After a minimum of 2 years, the infection control rate was of 95.3% (±0.02). Conclusion: One-stage exchange arthroplasty for FCPHIs showed a good infection control rate similar to that of non-fistulizing PHI. Systematic preoperative microbiological documentation with joint aspiration and, in some specific cases, the use of preoperative antibiotic therapy are among the optimizations accounting for the success of the one-stage arthroplasty. In light of these results, and those of other studies, international recommendations could evolve. Level of Evidence: Descriptive therapeutic prospective cohort study. Level of evidence: IV.

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Section: Discussioncontrasting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

et al. 2020

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“…Svensson et al analyzed the risk of re-revision in infected primary THAs treated with a one-stage (n=404) or two-stage (n=1250) exchange. They found no significant difference in overall survival rate, revision due to all causes, infection, or aseptic loosening [17]. A large systematic review found a rate of reinfection to be 8.6% for one-stage and 10.2% for two-stage infected THA revisions [18].…”

Section: Discussionmentioning

confidence: 99%

An Alternative One-Stage Exchange Arthroplasty Technique: For the Chronic Infected Total Hip

Kotecki

Hoang

LeCavalier

et al. 2020

Cureus

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Background There are various algorithms for the treatment of prosthetic joint infections (PJI). Currently, a two-stage hip exchange is considered the "gold standard" of care for treatment of chronic hip PJIs. However, there has been recent debate whether a one-or two-stage exchange offers the correct treatment. One-stage exchange arthroplasty has particularly gained interest due to less morbidity, mortality, and functional impairment. Methods In a retrospective case series, the outcome of patients with chronic hip PJIs treated with our one-stage exchange arthroplasty was analyzed. Between January 2015 and January 2020, eight patients underwent a one-stage exchange hip arthroplasty by a single surgeon at a single institution for a chronically infected total hip arthroplasty (THA). Original diagnosis of PJI was made in accordance with the 2011 version of the Musculoskeletal Infection Society (MSIS) criteria. The femoral stem was cemented with antibioticimpregnated cement, and the polyethylene acetabular liner was cemented directly onto the acetabular bone with antibiotic-impregnated cement. Results Of the eight patients, three were female and five were male with a mean age of 70.5 years (SD 11.2, range 53-87). Six patients (75%) had infection eradication with retention of a stable implant and no additional surgery at a mean follow-up of 35.7 months (range 17-50). One patient (12.5%) underwent closed reduction for a dislocated THA at one month; however, this patient remained infection-free at the most recent follow-up of 41 months. One patient (12.5%) who was the oldest patient (87 years) died 18 days postoperatively. Overall, all living patients (87.5%) retained their one-stage exchange THA. One patient (12.5%, CI 95% 0.3-52.7) required additional surgery in the form of a closed reduction and zero patients (0.0%, CI 95% 0.0-36.9) required additional open surgery. Conclusion Single-stage exchange arthroplasty with an antibiotic-impregnated cemented femoral stem and antibioticimpregnated cemented polyethylene acetabular liner may be a useful option for the treatment of chronic hip PJIs. Our case series provides evidence that infection eradication and function preservation are possible using our one-stage exchange arthroplasty technique in a chronically infected THA. However, a multi-center study with randomization is necessary to further validate our results.

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“…One-stage revision has recently gained more support because of its good clinical results and numerous advantages in carefully selected patients. A widely accepted consensus was reached on several strict exclusion criteria such as unknown or multiresistant organism-based infections, relevant comorbidities, sinus tract, and other relevant soft tissue complications [ 1 , 2 , 3 ]. Therefore, two-stage revision is still widely considered the gold standard treatment in the setting of chronic and complex periprosthetic joint infections.…”

Section: Introductionmentioning

confidence: 99%

Hip Spacers with a Metal-on-Cement Articulation Did Not Show Significant Surface Alterations of the Metal Femoral Head in Two-Stage Revision for Periprosthetic Joint Infection

et al. 2020

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Two-stage revision is considered the gold standard treatment for chronic periprosthetic joint infection (PJI). During the interim period, between explantation of the infected hip endoprosthesis and revision arthroplasty, individually formed articulating hip spacers made of polymethylmethacrylate (PMMA) bone cement can be used to provide better soft tissue preservation, local antibiotic release, and improved postoperative mobilization. If effective prevention from luxation is achieved, hip function and hence overall patient satisfaction is improved. Zirconium oxide particles inside conventional PMMA bone cement, however, are known to enhance third-body wear, which may cause alterations of the metal head in the articulating spacer and hence become a serious risk for the patient. Therefore, the aim of our study was to analyze whether the articular surface of cobalt-chrome (CoCr) femoral heads is significantly altered in the setting of a metal-on-cement articulation during the interim period of two-stage revision for PJI. We analyzed a consecutive series of 23 spacer cases and compared them with femoral heads from two series of conventional hip arthroplasty revisions with metal-on-polyethylene articulations and different time intervals in situ. To investigate metallic wear, the femoral heads were thoroughly examined, and their surface roughness was measured and analyzed. We found no significant differences between the two conventional hip arthroplasty groups, despite their very different times in situ. Furthermore, the individually different times in situ within the spacer group had no significant impact on surface roughness, either. Compared with the spacer group, the surface roughness of the metal femoral heads from both conventional hip arthroplasty groups were even higher. Within the spacer group, roughness parameters did not show significant differences regarding the five predefined locations on the metal head. We conclude that metal-on-cement articulations do not cause enhanced surface alterations of the metal femoral head and hence do not limit the application in articulating hip spacers in the setting of two-stage revision for PJI.

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Similar Risk of Re-Revision in Patients after One- or Two-Stage Surgical Revision of Infected Total Hip Arthroplasty: An Analysis of Revisions in the Swedish Hip Arthroplasty Register 1979–2015

Cited by 30 publications

References 25 publications

One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

An Alternative One-Stage Exchange Arthroplasty Technique: For the Chronic Infected Total Hip

Hip Spacers with a Metal-on-Cement Articulation Did Not Show Significant Surface Alterations of the Metal Femoral Head in Two-Stage Revision for Periprosthetic Joint Infection

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