Two-stage revision for periprosthetic joint infection of the hip: Culture-negative versus culture-positive infection

Santoso, Asep; Park, Kyung-Soon; Shin, Young-Rok; Yang, Hong-Yeol; Choi, In Suck; Yoon, Tae Mi

doi:10.1016/j.jor.2018.03.002

Cited by 11 publications

(9 citation statements)

References 17 publications

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“…Overall, the quality of the included studies was unsatisfactory. Four studies[ 15 , 19 , 22 , 24 ] were considered to have moderate risk of bias, and seven studies[ 18 , 20 , 21 , 23 , 25 - 27 ] were at significant risk of bias, which could be due to their retrospective nature. In most studies, PJI was diagnosed based on the 2011 Musculoskeletal Infection Society (MSIS) criteria.…”

Section: Resultsmentioning

confidence: 99%

Outcomes of culture-negative or -positive periprosthetic joint infections: A systematic review and meta-analysis

Lai,

Xu,

et al. 2023

Jt Dis Relat Surg

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Objectives: This study overviewed the current database of studies on periprosthetic joint infections (PJIs) to compare outcomes and antibiotic side effects in culture-negative or culture-positive PJIs and assess treatment options for culture-negative PJIs. Patients and methods: A systematic review and meta-analysis was undertaken using studies published before July 2022 in MEDLINE, EMBASE, and Cochrane Library. All studies comparing treatment of culture-negative or -positive PJIs were included. Afterward, the infection control rate, periprosthetic or spacer fracture, hip joint or spacer dislocation, and antibiotic side effects in different treatment methods of PJI were analyzed. Results: Eleven studies involving 1,747 patients were included. Most studies clearly defined the infection control criteria: no pain or swelling, no wound drainage, normal serology, and normal radiographic findings. Patients were followed until treatment failure, death, or until the last clinical visit without evidence of treatment failure. The two types of PJIs did not differ significantly in infection control rates (culture-negative PJI 79.2% vs. culture-positive PJI 76.6%; odds ratio [OR]=1.20, 95% confidence interval [CI]: 0.84 to 1.70), either after all types of surgical treatment or after two-stage revision arthroplasty (OR=1.12, 95% CI: 0.72 to 1.75), single-stage revision arthroplasty (OR=0.51, 95% CI: 0.19 to 1.37), or debridement, antibiotics, and implant retention (OR=0.88, 95% CI: 0.50 to 1.54). Similarly, we did not find differences in periprosthetic or spacer fracture and hip joint or spacer dislocation. For culture-negative PJIs, the infection control rate was 85.2% after two-stage revision arthroplasty, 90.6% after single-stage revision arthroplasty, and 69.7% after debridement, antibiotics, and implant retention. Data pooled from three studies showed higher incidence of antibiotic side effects for culture-negative PJIs. Conclusion: The clinical outcomes of one-stage revision and two-stage revision are comparable. Therefore, both of them can be considered in surgical treatment for culture-negative PJIs. In addition, limited data showed a higher incidence of antibiotic side effects in culture-negative PJIs.

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Section: Resultsmentioning

confidence: 99%

Outcomes of culture-negative or -positive periprosthetic joint infections: A systematic review and meta-analysis

Lai,

Xu,

et al. 2023

Jt Dis Relat Surg

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“…In some conditions, OSE is more effective, especially in cases infected by fungi. 8,12 This is usually only for THR infections. There is also considerable variation in the course of antimicrobial therapy and the duration after OSE.…”

Section: Discussionmentioning

confidence: 99%

“…9 Two-stage revision of prosthesis replacement procedures, involving administration of local and systemic antibiotics, then replanting after eradicating the infection, has become the "gold standard" for management in PJI with a success rate of more than 90%. [10][11][12] PJI treatment has a high failure rate, which in PJI can eventually lead to arthrodesis, amputation, and even death. 13 Selection of the right antibiotics with wise and rational use combined with adequate surgical procedures are important to avoid antibiotic resistance, so that the infection can be cured and joint function restored without pain.…”

mentioning

confidence: 99%

The profile of Hip and Knee Periprosthetic Joint Infection cases at Dr. Cipto Mangunkusumo Central National Referral Hospital

Wibowo

Dilogo²

2021

Hip Knee J.

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Background: The most troubling complication of joint replacement procedures is periprosthetic joint infection (PJI). Pathogen identification increases the likelihood of successful treatment. The data of PJI are mostly unpublished in Indonesia. In this study we aimed to investigate the characteristics of PJI of a national hospital in Indonesia. Material and methods: This research was a cross-sectional study. The inclusion criteria were patients diagnosed with PJI confirmed by examination of fluid exudate culture, sedimentation rate and C-Reactive Protein, which was accompanied by dislocation, fracture and/or loosening of the prosthetic joint and diagnosed between January 2019 to July 2020. Result: The mean age of patients who underwent revision surgery for PJI was 50.0 ± 14.69 years-old with a slightly higher proportion of men (63.6%). Of the 21 patients, some patients had a history of surgery more than once. The clinical outcome was assessed with the Harris Hip Score (HHS) and the Visual Analog Scale (VAS). The mean HHS of all hip replacement surgeries increased from 61.4 (48.15 to 68) before surgery to 82.5 (75.7 to 84) at the 12-month follow-up post last surgery (p=0.03). Likewise, the VAS value decreased from 3 (2 to 4) before surgery to 2 (1 to 2). Conclusion: Gram positive bacteria were more prevalent compared to gram negative bacteria. The difference in the microorganism spectrum could be one of several factors. This pattern should be explored in the future by adding more samples to the study. Overall, the clinical outcome was better in both total hip and knee arthroplasty patients, measured by the Harris hip score, visual analog scale, and the knee society score

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“…Periprosthetic joint infection (PJI) is a serious complication after joint arthroplasty with a prevalence between 2.05% and 2.18% [ 1 ]. The most common pathogens are gram-positive bacteria, such as Staphylococcus aureus and coagulase-negative Staphylococci (60%); gram-negative bacteria can also lead to opportunistic infections [ 2 , 3 ]. Among them, mycobacterial infections account for approximately 2% of all PJI cases [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

A case report on Mycobacterium houstonense infection after total hip arthroplasty

Li,

Yuan,

Cao

et al. 2023

BMC Infect Dis

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Background Mycobacterium houstonense is a category of rapidly growing mycobacteria that is gram-positive, acid-fast, polycrystalline, and non-spore-forming. There have been few reports of human infection caused by Mycobacterium houstonense worldwide. Case presentation We present a case of chronic periprosthetic joint infection caused by Mycobacterium houstonense in an elderly female patient. The patient developed signs of infection after undergoing total hip arthroplasty. Despite receiving antibiotic treatment and revision surgery, the signs of infection recurred repeatedly. Multiple bacterial cultures during the treatment period were negative. Later, we identified the pathogenic bacteria Mycobacterium houstonense through mNGS testing, isolated the bacteria from the ultrasonically centrifuged fluid of the prosthesis and obtained drug sensitivity results. Finally, we performed a revision surgery and treated the patient with moxifloxacin and clindamycin. After treatment, the patient did not show signs of infection recurrence during 24 months of follow-up. Conclusion Through a relevant literature search, we believe that Mycobacterium houstonense may show higher sensitivity to amikacin and quinolone antibiotics. Additionally, clarifying occult infection sources through methods such as gene testing will improve the diagnosis and treatment of periprosthetic joint infection.

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Two-stage revision for periprosthetic joint infection of the hip: Culture-negative versus culture-positive infection

Abstract: Two-stage revision resulted a comparable outcome for the treatment of culture-negative periprosthetic joint infection of the hip compared to the culture-positive group.

Cited by 11 publications

References 17 publications

Outcomes of culture-negative or -positive periprosthetic joint infections: A systematic review and meta-analysis

Outcomes of culture-negative or -positive periprosthetic joint infections: A systematic review and meta-analysis

The profile of Hip and Knee Periprosthetic Joint Infection cases at Dr. Cipto Mangunkusumo Central National Referral Hospital

A case report on Mycobacterium houstonense infection after total hip arthroplasty

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