The risk factors of failed reimplantation arthroplasty for periprosthetic hip infection

Jhan, Shun-Wun; Lu, Yu-Der; Lee, Mel S.; Lee, Chen‐Hsiang; Wang, Junwen; Kuo, Feng-Chih

doi:10.1186/s12891-017-1622-1

Cited by 44 publications

(21 citation statements)

References 27 publications

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“…Recurrence and repetitive infections may cause troublesome complications such as bone loss, poor soft tissue integrity, prolonged and complex operations, and physical and psychological disabilities. Because of the change in character of the remaining bone, the shear strength at the bone-cement interface is reduced and the cement-microinterlock necessary for long-term stability is lost [14,15]. In particular, in the setting of infection, when acetabular bone loss is severe, the challenge for surgeons can be even greater due to the difficulty in implanting a stable cement spacer while keeping in mind the need for future surgery [16,17].…”

Section: Discussionmentioning

confidence: 99%

The results of screw augmentation of acetabular cement spacers for the treatment of periprosthetic hip joint infection

et al. 2020

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Introduction Prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) is widely used in two-stage revision arthroplasty in periprosthetic joint infection (PJI) after total hip arthroplasty (THA). In our institution, we encountered several cases of acetabular cement spacer dislodgement. The aim of this study was to compare the results of two-stage revision arthroplasties with antibiotic-loaded cement spacers with or without screws on the acetabulum for PJI. Patients and methods This retrospective study included 44 patients who underwent a two-stage revision THA for PJI from June 2007 to May 2017. We divided the patients into two groups: group 1 consisted of 21 patients (21 hips) who underwent two-stage revision arthroplasty with screw augmentation, while group 2 consisted of 23 patients (23 hips) who underwent the same surgery without screw augmentation at the acetabular cement spacer. We compared the migration and dislodgement of the acetabular cement spacer between the two groups. Results Before the second-stage surgery, there was less vertical migration of the cement spacer in group 1 compared to group 2 (1.2 mm vs 3.1 mm, p < 0.001). There was also less medial migration of the cement spacer in group 1 (0.6 mm vs 1.6 mm, p = 0.001). After the first stage, the mean Harris Hip score was significantly higher in group 1 than in group 2 (75 vs 65, p = 0.033). Cement spacer rotation or total movement out of the acetabular area occurred in six patients, all in group 2. After first stage reinfection occurred in two patients, one in each group. Conclusions Screw augmentation to the acetabulum in the first-stage surgery provides better stability of acetabular antibiotic cement spacers without increasing reinfection rate.

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Section: Discussionmentioning

confidence: 99%

The results of screw augmentation of acetabular cement spacers for the treatment of periprosthetic hip joint infection

et al. 2020

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“…Several studies showed sonication of antibiotic spacers could disrupted biofilm and led to higher rates of positive intraoperative cultures [38, 39]. Kheir et al reported that positive leukocyte esterase (LE) strip test might be used in diagnosing persistent infection and resulted in a higher rate of subsequent failure [26]. Recently, Shahi et al reported D-dimer might be useful in diagnosing infection before reimplantation [16].…”

Section: Discussionmentioning

confidence: 99%

Outcomes and predictors of treatment failure following two-stage total joint arthroplasty with articulating spacers for evolutive septic arthritis

Xu¹,

Kuo

Kheir

et al. 2019

BMC Musculoskelet Disord

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Background The treatment strategy for evolutive septic arthritis (SA) with coexistent degenerative joint disease is not well established. The purposes of this study were to 1) investigate treatment outcome and potential risk factors of treatment failure in patients with evolutive SA following two-stage procedure, including insertion of an antibiotic-loaded spacer at the first stage and subsequent implantation of a new prosthesis; and 2) determine the performance of serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Interleukin-6 (IL-6) in predicting persisting infection at second-stage procedure. Methods We retrospectively reviewed 74 patients with evolutive SA of hips and knees who underwent a two-stage TJA between 2008 and 2015. The treatment success was defined according to the modified Delphi criteria and Kaplan-Meier survivorship curves were constructed to determine treatment success. A Cox regression model was performed to identify risk factors for treatment failure. Receiver operating characteristic (ROC) curves were generated to determine the prognostic value of ESR, CRP, and IL-6 in predicting persistent infection before second-stage prostheses implantation. Results Overall, the treatment success rate was 93% for hips and 100% for knees after the first-stage surgery. The treatment success rate was 89% for hips and 84% for knees after second-stage prosthesis implantation with a mean follow-up of 4.7 (range, 2.2 to 10.8) years. Older age (Hazard ratio [HR] [per 10-year increase], 1.20; 95% confidential interval [CI], 1.11 to 1.62), higher preoperative CRP level (HR [per 1-mg/dL increase], 1.15; 95% CI, 1.04 to 1.28) and resistant organism (HR, 13.96; 95% CI, 3.29 to 19.20) were associated with an increased risk of treatment failure. All serologic tests presented limited values in predicting persisting infection, with the area under ROC curve of ESR, CRP, IL-6 and combination of the three markers was 57.8, 61.6, 60.3, and 62.1%, respectively. Conclusions Two-stage TJA is an adequate management of infection control in patients with evolutive SA. The three potential risk factors (old age, high preoperative CRP, and resistant organism profile) may predict treatment failure following a two-stage procedure for evolutive SA. Additionally, serum ESR, CRP, and IL-6 had no benefit in predicting persisting infection before second-stage prostheses implantation. These findings may be useful when treating patients with evolutive SA.

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“…Compared to the current literature of single-stage revision surgery with eradication-rates of 70% to over 90% and two-stage revision surgery with eradication-rates of 80% up to over 90% our results are comparable. 7,[16][17][18][19][27][28][29][30][31][32][33][34] The reason for the high infection control might be due to the young age with less comorbidity of the cohort group and an intact immune system of patients selected for this study. We herewith provide the first data in young patients undergoing single-stage septic revision in patients with PJI in THA, justifying this approach.…”

Section: Discussionmentioning

confidence: 99%

Results at 10–24 years after single-stage revision arthroplasty of infected total hip arthroplasty in patients under 45 years of age

et al. 2019

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Introduction: The management of periprosthetic joint infection (PJI) of the hip is a challenging procedure. One-stage exchange is carried out in specialist centres with comparable infection free survival rates. However, there is a paucity of long-term results of this approach in young patients. Methods: All patients undergoing one-stage exchange due to PJI with a known causative organism ⩽45 years of age with a minimum of 10-year follow-up (mean 15 years; range 10–24 years) were enrolled in this retrospective study. Patients older than 45 years of age or patients with a two-stage procedure were excluded from the study. The primary outcome measure was failure rate with special focus on reinfection at latest follow-up. Failure was defined as revision surgery for infection. Furthermore, functional outcome using the Harris Hip Score was determined initially and at latest follow-up. 26 patients fulfilled the inclusion criteria and were available for final follow-up. Results: The study cohort consists of 16 male and 10 female patients with a mean age of 36.8 years (range 20–45 years) and a mean BMI of 29.8 kg/m2 (range 20.7–40.6 kg/m2). Prior to the single-stage procedure, the patients underwent an average of 3.1 previous surgical interventions (range 1–9). The mean hospital stay after septic revision was 19.7 days (11–33 days). Most infections were caused by Staphylococcus epidermidis ( n = 8, 30.8%), followed by Staph. aureus ( n = 7, 26.9%) and Propionibacterium acnes ( n = 6, 23.1%). At latest follow-up, the overall survival rate was 76.9 %, while infection control could be achieved in 96.2%. At final examination, the mean Harris Hip Score improved from 46.2 to 78.9 (range 18.0–99; SD, 22.6). Conclusions: Single-stage revision surgery for the management of PJI in patients ⩽45 years is a successful treatment option with high infection control, even after long-term follow-up.

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The risk factors of failed reimplantation arthroplasty for periprosthetic hip infection

Cited by 44 publications

References 27 publications

The results of screw augmentation of acetabular cement spacers for the treatment of periprosthetic hip joint infection

The results of screw augmentation of acetabular cement spacers for the treatment of periprosthetic hip joint infection

Outcomes and predictors of treatment failure following two-stage total joint arthroplasty with articulating spacers for evolutive septic arthritis

Results at 10–24 years after single-stage revision arthroplasty of infected total hip arthroplasty in patients under 45 years of age

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