Two-stage arthroplasty for septic arthritis of the hip and knee: A systematic review on infection control and clinical functional outcomes

Russo, Antonio; Cavagnaro, Luca; Alessio-Mazzola, Mattia; Felli, Lamberto; Burastero, Giorgio; Formica, Matteo

doi:10.1016/j.jcot.2021.101720

Cited by 7 publications

(4 citation statements)

References 56 publications

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“…With femoral head osteomyelitis upon diagnosis and severe acetabular erosions, her infection would have been difficult to eradicate with irrigation and debridement alone. In this setting, a two-stage procedure can be performed with a temporary Girdlestone procedure or antibiotic spacer implantation [ 21 ]. Two-staged arthroplasty in the setting of late-stage septic hip arthritis allows for high rates of infection control and typically provides good to excellent functional outcomes [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

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Bilateral Erosive Septic Hip Arthritis Following Pregnancy

2022

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Section: Discussionmentioning

confidence: 99%

“…In this setting, a two-stage procedure can be performed with a temporary Girdlestone procedure or antibiotic spacer implantation [ 21 ]. Two-staged arthroplasty in the setting of late-stage septic hip arthritis allows for high rates of infection control and typically provides good to excellent functional outcomes [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Erosive Septic Hip Arthritis Following Pregnancy

2022

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“…Native Joint Septic Arthritis Russo et al performed a systematic review on 2-stage exchange for native septic arthritis of the hip and knee. Using 21 studies comprising 435 procedures, the authors found an eradication rate of 93.3% at mean follow-up of 53.7 months 77 . Bettencourt et al analyzed 215 patients with a history of septic arthritis of the native knee who underwent TKA.…”

Section: Handmentioning

confidence: 99%

What’s New in Musculoskeletal Infection

Otero

Brown

Courtney

et al. 2022

Journal of Bone and Joint Surgery

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Periprosthetic joint infection (PJI) remains the most dreaded complication after total joint arthroplasty (TJA). As reimbursement for joint replacement continues to decline [1][2][3] , fewer orthopaedic surgeons take on this challenging and timeconsuming practice. Indeed, in a recent study, Keely Boyle et al. found that 16% of knee arthroplasty revisions, including revisions for infection, were performed at a different center than the one in which the index procedure was performed. Illgen et al. used the American Joint Replacement Registry (AJRR) to show that, in hips, the migration rate for PJI ranges from 28.6% to 46.6%, depending on the size of the hospital 5 . This places a major portion of the responsibility of PJI care on a few specialized surgeons. Therefore, understanding the economics of PJI care has been a hot topic this year.In a study utilizing the National Inpatient Sample (NIS), Premkumar et al. projected that, by 2030, the annual hospital costs related to PJI of the hip and knee will equal $1.85 billion in the United States 6 . In another study from a single institution, the cost of care for a PJI after a 2-stage total knee arthroplasty (TKA) was more than 5 times the cost of care of an uncomplicated primary TKA for an age-matched and body mass index (BMI)-matched cohor t 7 . Comparing the cost of operative treatment for PJI of the hip and knee with that of aseptic revision, Yao et al. 8 showed that the PJI treatment had costs that were double those of the aseptic treatment. Unintended hospitalization during the 2-stage exchange process was shown to add >$20,000 in costs to patient care, which is concerning because less than one-half of the patients who underwent resection for PJI had a successful 2-stage exchange within 1 year 9 . Using a Markov model, Antonios et al. showed the costeffectiveness of adding a planned second debridement, antibiotics, and implant retention (DAIR) procedure to treat PJI 10 . Efforts to reduce failure in PJI treatment will continue to be an important topic in research. PreventionAlthough originally spoken to Philadelphians to increase fire awareness in the 1700s, Benjamin Franklin's famous quote, "An ounce of prevention is worth a pound of cure," certainly still applies to PJI. With the substantial clinical and financial burden of PJI, resources should be focused, not just on treatment, but on optimizing strategies to prevent infection. Many studies published on this topic at this time will help to guide orthopaedic surgeons and their perioperative management of patients undergoing total hip arthroplasty (THA) and TKA, while prompting more prospective studies to answer important questions.Preoperative Staphylococcus aureus screening is controversial. In a recent systematic review and meta-analysis with 32 studies, Ribau et al. identified a marked reduction in infection with decolonization prior to elective THA and TKA 11 . However, in a randomized controlled trial (RCT) of 613 patients, Rohrer et al. did not find a difference in PJI rates with nasal decolonization, but...

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“…Treatment of acute bacterial arthritis consists of surgical intervention and antibiotic therapy (Goldberg and Sexton, 2022;Balato et al, 2021;Lum et al, 2018;Ross, 2017;Mathews et al, 2010;Rutz and Brunner, 2009). Surgical modalities range from arthroscopic or open debridement to (staged) total hip arthroplasty (THA) and (modified) Girdlestone procedures, using a variety of anatomical approaches (Balato et al, 2021;D'Angelo et al, 2021;Russo et al, 2021;Davis and Zamora, 2020;Lum et al, 2018;Rutz and Brunner, 2009).…”

Section: Introductionmentioning

confidence: 99%

Advanced imaging shows extra-articular abscesses in two out of three adult patients with septic arthritis of the native hip joint

Cools,

Ghijselings,

Ruythooren

et al. 2024

J. Bone Joint Infect.

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Abstract. Background: Septic arthritis (SA) of the native adult hip is a rare orthopaedic emergency requiring prompt diagnosis and treatment. As clinical presentation and laboratory findings are frequently atypical, advanced imaging is often requested. This retrospective study aimed to investigate the prevalence and pattern of extra-articular infectious manifestations and their implications for pre-operative advanced imaging in patients with proven SA of the native hip joint. Methods: Out of 41 patients treated surgically for SA of the native hip during a 16-year period at our tertiary referral hospital, 25 received advanced imaging (computed tomography (CT), magnetic resonance imaging (MRI), or fluorodeoxyglucose positron emission tomography (FDG PET-CT)) prior to initial intervention. For each investigation, a specific set of variables was systematically interpreted, and the most suitable surgical approach was determined. The prognostic value was evaluated by comparing specific outcome measures and the extent of extra-articular involvement. Results: It was found that 32 % of patients had an abscess in one anatomical region, 32 % of patients had abscesses in multiple anatomical regions, and only 36 % of patients had no substantial abscess. Gluteal abscesses were especially common in patients with SA due to contiguous spread. Abscesses in the iliopsoas region were more common in patients with SA due to hematogenous seeding. A combination of several different surgical approaches was deemed necessary to adequately deal with the various presentations. No significant prognostic factors could be identified. Conclusion: We recommend performing advanced imaging in patients with suspected or proven septic arthritis of the native hip joint, as extra-articular abscesses are present in 64 % and might require varying anatomical approaches.

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Two-stage arthroplasty for septic arthritis of the hip and knee: A systematic review on infection control and clinical functional outcomes

Cited by 7 publications

References 56 publications

Bilateral Erosive Septic Hip Arthritis Following Pregnancy

Bilateral Erosive Septic Hip Arthritis Following Pregnancy

What’s New in Musculoskeletal Infection

Advanced imaging shows extra-articular abscesses in two out of three adult patients with septic arthritis of the native hip joint

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