Two-Stage Revision Protocol in Multidrug Resistant Periprosthetic Infection Following Total Hip Arthroplasty Using a Long Interval Between Stages

Babis, George C.; Sakellariou, Vasileios I.; Pantos, Panayiotis G; Sasalos, Gregory; Stavropoulos, Nikolaos A.

doi:10.1016/j.arth.2015.04.004

Cited by 20 publications

(17 citation statements)

References 48 publications

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“…Time intervals between particular stages ranging from 3 weeks to 9.2 months do not seem to affect the final outcome of the two-stage procedure in the hip. 19 , 20 Aalirezaie et al 21 concluded that the length of the inter-stage interval (mean of 100.2 days) has no statistical significance in predicting failure of two-stage exchange.…”

Section: Discussionmentioning

confidence: 99%

Two-stage revision arthroplasty in the treatment of periprosthetic hip infections with severe bone loss: Results from 182 cases

Białecki¹,

Kogut²,

Chaberek³

et al. 2020

Orthop Rev (Pavia)

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The optimum treatment for periprosthetic joint infection (PJI) of the hip with substantial bone defects remains controversial. A retrospective assessment was performed for 182 patients treated for PJI with a two-stage protocol from 2005 to 2015. Implant removal and debridement were followed by Girdlestone arthroplasty or spacer implantation. The results of the Girdlestone and spacer groups were compared. There were 71 cases that received spacers, and 111 Girdlestone procedures were performed. After the first stage, 26.37% of cultures were negative, and among patients with a detected pathogen, methicillin-sensitive Staphylococcus aureus was the most common organism (41.79%). Acetabular and femoral bone defects, according to the Paprosky classification, were more severe in the Girdlestone group (P<0.05). During the follow-up (mean, 5.95 years), the overall incidence of complications was 21.42%. The mean Harris hip score was significantly lower in the Girdlestone group (68.39 vs 77.79; P<0.0001). The infection recurrence rate reached 8.79%. Despite satisfactory infection control, the number of complications and poor functional outcomes associated with resection arthroplasty indicate the necessity for development of different approaches for patients with advanced bone loss.

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Section: Discussionmentioning

confidence: 99%

Two-stage revision arthroplasty in the treatment of periprosthetic hip infections with severe bone loss: Results from 182 cases

Białecki¹,

Kogut²,

Chaberek³

et al. 2020

Orthop Rev (Pavia)

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“…Current treatment strategies with antibiotic spacers confer substantial psychological and physical burden on patients, entailing at least two additional major operations with corresponding physical limitations and the longterm use of potentially noxious antibiotics. Despite this aggressive approach, up to 35% of patients are unable to clear their infections and may require a multitude of salvage procedures (e.g., fusion, resection arthroplasty, amputation) [11][12][13][14] . While the effects of these grave salvage procedures on the individual are presumably morbid, the burden to society is also great.…”

Section: Discussionmentioning

confidence: 99%

Reducing Dislocations of Antibiotic Hip Spacers via Hybrid Cement-screw Constrained Liner Fixation: A Case Series

et al. 2020

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Purpose Infection following total hip arthroplasty is a challenging and devastating complication. In two-stage revision arthroplasty, antibiotic spacers, although efficacious, can be associated with an unacceptable rate of mechanical complications (e.g., fracture, dislocation). This series describes 15 patients with infected total hip prostheses treated with hybrid cement-screw fixation constrained liner antibiotic spacers to enhance stability and minimize mechanical complications. Materials and Methods All patients with an infected hip prosthesis undergoing two-stage revision arthroplasty at a single academic medical center were identified and screened for inclusion. Clinical and radiographic data including patient demographics and outcome measures were collected and retrospectively analyzed. Results Two patients died of unrelated causes at an average of 6-week postoperatively. Infections in the remaining thirteen patients (100%) were successfully eradicated; all underwent uncomplicated revision arthroplasty at a mean duration of 99.5 days after the placement of the antibiotic spacer. No dislocations, fractures, or other mechanical failures of any spacer were observed in this series. Conclusion The hybrid cement-screw fixation technique for constrained liner antibiotic spacers is a reliable and effective treatment method for eradicating prosthetic joint infections without mechanical complications.

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“…Lastly, synovial fluid aspiration in the presence of a spacer, prior to second stage reimplantation, showed poor sensitivity 21% (negative predictive value 51%, specificity 100%, positive predictive value 100%) for the detection of a persistent knee infection [ 53 ]. In this latter study, the final diagnosis of a persistent infection was based on intraoperatively acquired cultures and pathology samples during the second stage surgery.…”

Section: Spacer Exchangementioning

confidence: 99%

“…Outcomes were comparable as only one patient had a persistent infection in the long interval group compared to none in the short interval group; pain and functional outcomes assessed by patient reported outcomes surveys were similar as well. In contrast, when it comes to multidrug resistant organisms, a long interval to reimplantation appears to be safe and beneficial: Babis et al [ 53 ] reported a 100% success in treating 32 hip resistant infections with a prolonged time to interval period of mean 9.2 months (range, 8–12 months). Of note, authors used long durations of intravenous antibiotic therapy (mean 5.1 weeks, range 4–6 weeks) followed by long-term oral administration (mean 17 weeks, range 12–21 weeks).…”

Section: Spacer Exchangementioning

confidence: 99%

Is There a Role for Spacer Exchange in Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection?

Kozaily

Chisari

Parvızı

2020

JCM

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Periprosthetic joint infection (PJI) continues to be one of the most serious complications after hip and knee arthroplasty. The choice of surgical treatment depends on a multitude of factors like chronicity of infection, host factors, and institutional or surgeon experience. Two-stage exchange remains one of the most commonly used technique for chronic PJI in the United States of America. The intended two-stage revision may involve an additional interim procedure where the initial antibiotic cement spacer is removed and a new spacer is inserted. Mostly, the rationale behind spacer exchange is an additional load of local antibiotics before proceeding to reimplantation. There is no conclusive evidence whether a spacer exchange confers additional benefits, yet it delays reimplantation and exposes already fragile patients to the risks and morbidity of an additional surgery.

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Two-Stage Revision Protocol in Multidrug Resistant Periprosthetic Infection Following Total Hip Arthroplasty Using a Long Interval Between Stages

Cited by 20 publications

References 48 publications

Two-stage revision arthroplasty in the treatment of periprosthetic hip infections with severe bone loss: Results from 182 cases

Two-stage revision arthroplasty in the treatment of periprosthetic hip infections with severe bone loss: Results from 182 cases

Reducing Dislocations of Antibiotic Hip Spacers via Hybrid Cement-screw Constrained Liner Fixation: A Case Series

Is There a Role for Spacer Exchange in Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection?

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