1
|
Higashihira S, Simpson SJ, Arnold CJ, Deckard ER, Meneghini RM, Greenfield EM, Buller LT. Biofilm Formation is Durably Prevented on Pre-Fabricated Antibiotic Cement Spacers Compared to Cobalt Chrome and Polyethylene. J Arthroplasty 2024:S0883-5403(24)00909-4. [PMID: 39233097 DOI: 10.1016/j.arth.2024.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND A two-stage revision remains the standard for managing chronic periprosthetic joint infection (PJI). Despite multiple spacer options, whether a particular one better resists biofilm formation remains unclear. Prefabricated polymethylmethacrylate (PMMA) articulating spacers containing antibiotics and a proprietary pore structure were developed to increase antibiotic elution characterized by a rapid burst phase for the initial 1 to 2 days and an extended slow-release phase for > 28 days. This in vitro study determined whether biofilm formation is prevented during the initial rapid burst phase and/or the slow-release phase. METHODS S. aureus-Xen36 was incubated in 1.5 ml of Luria-Bertani broth with PMMA discs with the proprietary pore structure either with or without gentamycin and vancomycin, or with 'Hoffman style' positive-control discs (ultra-high molecular weight polyethylene (UHMWPE) or cobalt-chrome). Non-adherent bacteria were removed by three Phosphate Buffered Saline rinses every 20 to 24 hours. Planktonic bacterial growth in the culture broth and biofilm formation on the discs were measured by Colony Forming Unit (CFU) counting and resazurin reduction assays. Experiments were repeated > 4 times. RESULTS No detectable planktonic bacterial growth or biofilm formation occurred in cultures containing PMMA with antibiotics (≤ 15 CFUs/disc), whereas biofilms formed on PMMA without antibiotics, UHMWPE, and cobalt-chrome (1x107 to 4x108 CFUs/disc, P < 0.0001). Biofilm formation was confirmed by a 100-fold decrease in sensitivity to vancomycin. To determine whether the antibiotic slow-release phase is sufficient to block biofilm formation, PMMA discs with antibiotics were pre-eluted for 14 days with multiple saline changes prior to bacterial inoculation. After antibiotic elution, still no detectable biofilms formed on PMMA discs with antibiotics (≤ 15 CFUs/disc, P <0.0001). CONCLUSION Antibiotic release during both the initial and slow-release phases prevented biofilm formation on PMMA with the proprietary pore structure. This may translate into improved infection eradication rates clinically.
Collapse
Affiliation(s)
- Shota Higashihira
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana; Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Stefanie J Simpson
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christopher J Arnold
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | | | - Edward M Greenfield
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Leonard T Buller
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
| |
Collapse
|
2
|
Sanderson G, Olsen A, Nabet A, Goldman A. A simplified approach for the surgical treatment of hip and knee periprosthetic joint infections. J Orthop 2024; 47:58-62. [PMID: 38022845 PMCID: PMC10679533 DOI: 10.1016/j.jor.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Galen Sanderson
- Bone and Joint Sports Medicine Institute, Naval Medical Center Portsmouth, VA, 620 John Paul Jones Circle, Portsmouth, VA, 23708, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Aaron Olsen
- Bone and Joint Sports Medicine Institute, Naval Medical Center Portsmouth, VA, 620 John Paul Jones Circle, Portsmouth, VA, 23708, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Austin Nabet
- Bone and Joint Sports Medicine Institute, Naval Medical Center Portsmouth, VA, 620 John Paul Jones Circle, Portsmouth, VA, 23708, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Ashton Goldman
- Bone and Joint Sports Medicine Institute, Naval Medical Center Portsmouth, VA, 620 John Paul Jones Circle, Portsmouth, VA, 23708, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
3
|
Nace J, Chen Z, Bains SS, Kahan ME, Gilson GA, Mont MA, Delanois RE. 1.5-Stage Versus 2-Stage Exchange Total Hip Arthroplasty for Chronic Periprosthetic Joint Infections: A Comparison of Survivorships, Reinfections, and Patient-Reported Outcomes. J Arthroplasty 2023; 38:S235-S241. [PMID: 36878441 DOI: 10.1016/j.arth.2023.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Management of periprosthetic joint infection after total hip arthroplasty (THA) has traditionally consisted of a 2-stage approach. However, 1.5-stage exchange has garnered recent interest. We compared 1.5-stage to 2-stage exchange recipients. Specifically, we assessed (1) infection-free survivorship and risk factors for reinfection; (2) 2-year surgical/medical outcomes (eg, reoperations, readmissions); (3) Hip Disability and Osteoarthritis Outcome Scores for Joint Replacement (HOOS-JR); and (4) radiographic outcomes (ie, progressive radiolucent lines, subsidences, and failures). METHODS We reviewed a consecutive series of 1.5-stage or planned 2-stage THAs. A total of 123 hips were included (1.5-stage: n = 54; 2-stage: n = 69) with mean clinical follow-up of 2.5 years (up to 8 years). Bivariate analyses assessed incidences of medical and surgical outcomes. Additionally, HOOS-JR scores and radiographs were evaluated. RESULTS The 1.5-stage exchange had 11% greater infection-free survivorship at final follow-up compared to 2 stages (94% versus 83%, P = .048). Morbid obesity was the only independent risk factor demonstrating increased reinfection among both cohorts. No differences in surgical/medical outcomes were observed between groups (P = .730). HOOS-JR scores improved markedly for both cohorts (1.5-stage difference = 44.3, 2-stage difference = 32.5; P < .001). A total of 82% of 1.5-stage patients did not demonstrate progressive femoral or acetabular radiolucencies, while 94% of 2-stage recipients did not have femoral radiolucencies and 90% did not have acetabular radiolucencies. CONCLUSION The 1.5-stage exchange appeared to be an acceptable treatment alternative for periprosthetic joint infections after THAs with noninferior infection eradication. Therefore, this procedure should be considered by joint surgeons for treatment of periprosthetic hip infections.
Collapse
Affiliation(s)
- James Nace
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Zhongming Chen
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Sandeep S Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael E Kahan
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Gregory A Gilson
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Ronald E Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| |
Collapse
|
4
|
Buller LT, Eccles CJ, Deckard ER, Ziemba-Davis M, Meneghini RM. The Fate and Relevance of the Patella in Two-Stage Revision Total Knee Arthroplasty for Periprosthetic Joint Infection. J Arthroplasty 2022; 37:2090-2096. [PMID: 35533823 DOI: 10.1016/j.arth.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It remains unclear whether reimplantation of a patellar component during a two-stage revision for periprosthetic total knee arthroplasty infection (PJI) affects patient reported outcome measures (PROMs) or implant survivorship. The purpose of this study was to evaluate whether patellar resurfacing during reimplantation confers a functional benefit or increases implant survivorship after two-stage treatment for PJI. METHODS Two-stage revisions for knee PJI performed by three surgeons at a single tertiary care center were reviewed retrospectively. All original patellar components and cement were removed during resection and the patella was resurfaced whenever feasible during reimplantation. PROMs, implant survivorship, and radiographic measurements (patellar tilt and displacement) were compared between knees reimplanted with a patellar component versus those without a patellar component. RESULTS A total of 103 patients met the inclusion criteria. Forty-three patients (41.7%) underwent reimplantation with, and 60 patients (58.3%) without a patellar component. At a mean follow-up of 33.5 months, there were no significant differences in patient demographics or PROMs between groups (P ≥ .156). No significant differences were found in the estimated Kaplan-Meier all-cause, aseptic, or septic survivorship between groups (P ≥ .342) at a maximum of 75 months follow-up. There was no significant difference in the change (pre-resection to post-reimplant) of patellar tilt (P = .504) or displacement (P = .097) between the groups. CONCLUSION Patellar resurfacing during knee reimplantation does not appear to meaningfully impact postoperative PROMs or survivorship. Given the risk of potential extensor mechanism complications with patellar resurfacing, surgeons may choose to leave the patella without an implant during total knee reimplantation and expect similar clinical outcomes. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Leonard T Buller
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, Indiana
| | - Christian J Eccles
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary Ziemba-Davis
- IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, Indiana
| |
Collapse
|
5
|
Kelly MP, Gililland JM, Blackburn BE, Anderson LA, Pelt CE, Certain LK. Extended Oral Antibiotics Increase Bacterial Resistance in Patients Who Fail 2-Stage Exchange for Periprosthetic Joint Infection. J Arthroplasty 2022; 37:S989-S996. [PMID: 35074446 DOI: 10.1016/j.arth.2022.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/03/2022] [Accepted: 01/12/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although studies have demonstrated reductions in recurrent periprosthetic joint infection (PJI) with the administration of prolonged oral antibiotics at second-stage reimplantation, the potential for increasing bacterial resistance has not been studied. The purpose of this study was to determine if oral antibiotics at second-stage reimplantation increased the rate of antibiotic resistance in subsequent infections. METHODS We retrospectively reviewed patients who underwent 2-stage exchange for chronic PJI from 2014 to 2019. We compared those who had received prolonged oral antibiotics at the time of stage 2 reimplantation with those who did not. The primary outcome was the presence of resistant organisms in any subsequent infection. The secondary outcome was the overall rate of recurrent PJI in the 2 groups. Multivariable analyses controlling for demographics and comorbid conditions were used. RESULTS Of the 211 patients who underwent 2-stage exchange for PJI, 158 patients received prolonged oral antibiotics. The mean follow-up was 2.2 years. Recurrent PJI was diagnosed in 24 of 158 (15%) patients who received oral antibiotics compared with 11 of 53 (21%) patients who did not receive antibiotics (P = .35). PJI with resistant organisms was identified in 16 of 24 (67%) patients who received antibiotics compared with 0 of 11 (0%) patients who did not receive antibiotics (P = .0001). CONCLUSIONS Prolonged oral antibiotics following 2-stage exchange increase drug resistance to that antibiotic in subsequent PJI. We recommend further research in the area to refine antimicrobial protocols as we consider the risks and benefits of prolonged antibiotic treatment.
Collapse
Affiliation(s)
- Mick P Kelly
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Brenna E Blackburn
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Lucas A Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Christopher E Pelt
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Laura K Certain
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT; Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| |
Collapse
|
6
|
Time Required for Planned and Unplanned Episodes of Care in Septic Two-Stage Revision Hip and Knee Arthroplasty. J Arthroplasty 2022; 37:616-623. [PMID: 35026363 DOI: 10.1016/j.arth.2022.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/18/2021] [Accepted: 01/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Septic revision total hip (rTHA) and knee (rTKA) arthroplasty requires more effort but is reimbursed less than primary procedures per minute of intraoperative time. This study quantified planned and unplanned work performed by the surgical team for septic 2-stage revision surgeries during the entire episode-of-care "reimbursement window" and compared that time to allowable reimbursement amounts. METHODS Between October 2010 and December 2020 all unilateral septic 2-stage rTHA and rTKA procedures performed by a single surgeon at a single institution were retrospectively reviewed. Time dedicated to planned work was calculated over each episode of care, from surgery scheduling to 90 days postoperatively. Impromptu patient inquiries and treatments after discharge, but within the episode of care, involving the surgeon/surgeon team constituted unplanned work. Planned and unplanned work minutes were summed and divided by the number of patients reviewed to obtain average minutes of work per patient. RESULTS Sixty-eight hips and 64 knees were included. For 2-stage rTHA and rTKA the average time per patient for planned care was 1728 and 1716 minutes and for unplanned care was 339 and 237 minutes. Compared to the Centers for Medicare and Medicaid Services' allowable reimbursement times, an additional 799 and 887 minutes of uncompensated time was required to care for 2-stage rTHA and rTKA patients. CONCLUSION Two-stage revision procedures are substantially more complex than primary procedures. Financially disincentivizing surgeons to care for these patients reduces access to care when high-quality care is most needed. These findings support increasing the allowable times for 2-stage septic revision cases.
Collapse
|
7
|
Neufeld ME, Liechti EF, Soto F, Linke P, Busch SM, Gehrke T, Citak M. High revision rates following repeat septic revision after failed one-stage exchange for periprosthetic joint infection in total knee arthroplasty. Bone Joint J 2022; 104-B:386-393. [PMID: 35227090 DOI: 10.1302/0301-620x.104b3.bjj-2021-0481.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS The outcome of repeat septic revision after a failed one-stage exchange for periprosthetic joint infection (PJI) in total knee arthroplasty (TKA) remains unknown. The aim of this study was to report the infection-free and all-cause revision-free survival of repeat septic revision after a failed one-stage exchange, and to determine whether the Musculoskeletal Infection Society (MSIS) stage is associated with subsequent infection-related failure. METHODS We retrospectively reviewed all repeat septic revision TKAs which were undertaken after a failed one-stage exchange between 2004 and 2017. A total of 33 repeat septic revisions (29 one-stage and four two-stage) met the inclusion criteria. The mean follow-up from repeat septic revision was 68.2 months (8.0 months to 16.1 years). The proportion of patients who had a subsequent infection-related failure and all-cause revision was reported and Kaplan-Meier survival for these endpoints was determined. Patients were categorized according to the MSIS staging system, and the association with subsequent infection was analyzed. RESULTS At the most recent follow-up, 17 repeat septic revisions (52%) had a subsequent infection-related failure and the five-year infection-free survival was 59% (95% confidence interval (CI) 39 to 74). A total of 19 underwent a subsequent all-cause revision (58%) and the five-year all-cause revision-free survival was 47% (95% CI 28 to 64). The most common indication for the first subsequent aseptic revision was loosening. The MSIS stage of the host status (p = 0.663) and limb status (p = 1.000) were not significantly associated with subsequent infection-related failure. CONCLUSION Repeat septic revision after a failed one-stage exchange TKA for PJI is associated with a high rate of subsequent infection-related failure and all-cause revision. Patients should be counselled appropriately to manage expectations. The host and limb status according to the MSIS staging system were not associated with subsequent infection-related failure. Cite this article: Bone Joint J 2022;104-B(3):386-393.
Collapse
Affiliation(s)
- Michael E Neufeld
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.,Department of Orthopaedics, Division of Lower Limb Reconstruction, University of British Columbia, Vancouver, Canada
| | - Emanuel F Liechti
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.,Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fernando Soto
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.,Department of Orthopaedic Surgery, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - Philip Linke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | | | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| |
Collapse
|
8
|
Liechti EF, Neufeld ME, Soto F, Linke P, Busch SM, Gehrke T, Citak M. Favourable outcomes of repeat one-stage exchange for periprosthetic joint infection of the hip. Bone Joint J 2022; 104-B:27-33. [PMID: 34969284 DOI: 10.1302/0301-620x.104b1.bjj-2021-0970.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS One-stage exchange for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) is gaining popularity. The outcome for a repeat one-stage revision THA after a failed one-stage exchange for infection remains unknown. The aim of this study was to report the infection-free and all-cause revision-free survival of repeat one-stage exchange, and to investigate the association between the Musculoskeletal Infection Society (MSIS) staging system and further infection-related failure. METHODS We retrospectively reviewed all repeat one-stage revision THAs performed after failed one-stage exchange THA for infection between January 2008 and December 2016. The final cohort included 32 patients. The mean follow-up after repeat one-stage exchange was 5.3 years (1.2 to 13.0). The patients with a further infection-related failure and/or all-cause revision were reported, and Kaplan-Meier survival for these endpoints determined. Patients were categorized according to the MSIS system, and its association with further infection was analyzed. RESULTS A total of eight repeat septic revisions (25%) developed a further infection-related failure, and the five-year infection-free survival was 81% (95% confidence interval (CI) 57 to 92). Nine (28%) underwent a further all-cause revision and the five-year all-cause revision-free survival was 74% (95% CI 52 to 88). Neither the MSIS classification of the host status (p = 0.423) nor the limb status (p = 0.366) was significantly associated with further infection-related failure. CONCLUSION Repeat one-stage exchange for PJI in THA is associated with a favourable five-year infection-free and all-cause revision-free survival. Notably, the rate of infection control is encouraging when compared with the reported rates after repeat two-stage exchange. The results can be used to counsel patients and help clinicians make informed decisions about treatment. With the available number of patients, further infection-related failure was not associated with the MSIS host or limb status. Cite this article: Bone Joint J 2022;104-B(1):27-33.
Collapse
Affiliation(s)
- Emanuel F Liechti
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany.,Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael E Neufeld
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany.,Department of Orthopaedic Surgery, Lower Limb (Adult Hip & Knee) Reconstruction, The University of British Columbia, Vancouver, Canada
| | - Fernando Soto
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany.,Department of Orthopaedic Surgery, Hospital Naval de Viña del Mar Almirante Nef, Vina del Mar, Chile
| | - Philip Linke
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany
| | - Sophia-Marlene Busch
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany
| |
Collapse
|
9
|
Li K, Cuadra M, Scarola G, Odum S, Otero J, Griffin W, Springer BD. Complications in the treatment of periprosthetic joint infection of the hip: when do they occur? J Bone Jt Infect 2021; 6:295-303. [PMID: 34377629 PMCID: PMC8339596 DOI: 10.5194/jbji-6-295-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/23/2021] [Indexed: 11/29/2022] Open
Abstract
Prosthetic joint infection (PJI) is a devastating complication after total
hip arthroplasty (THA). The common treatment in the USA is a two-stage
exchange which can be associated with significant morbidity and mortality.
The purpose of this study was to analyze complications in the treatment
course of patients undergoing two-stage exchange for PJI THA and determine
when they occur.
Methods:
We analyzed all patients that underwent two-stage exchange arthroplasty for
treatment of PJI after THA from January 2005 to January 2018 at a single
institution. Complications were categorized as medical or surgical and divided
into interstage and post-reimplantation. Minimum follow-up was 1 year.
Success was based on the MusculoSkeletal Infection Society (MSIS)
definition.
Results:
205 hips (203 patients) underwent first stage of planned two-stage exchange.
The median age was 68 (interquartile range (IQR) 18). There were 97 males and 106 females.
Overall, 73/205 (38 %) patients had at least one complication during
treatment: 13.5 % (25/185) of patients experienced a medical complication
and 28.1 % (52/185) a surgical complication; 2.4 % died within 1 year
of surgery, and 4.9 % (15/203) had mortality at a median of 2.5 years (IQR 4.9); 27 % of patients had complications during the interstage period, most commonly being recurrence of infection requiring additional surgery
(63 %); and 14 % of patients experienced a complication following
reimplantation, most commonly persistence or recurrence of infection
(59 %). While 92 % of patients that initiated treatment were ultimately
reimplanted, only 69 % were infection free at 1 year and required no
additional treatment.
Conclusions:
While two-stage exchanges for PJI in THA have been reported as successful,
there are few reports of the complications during the process. In our
series, significant numbers of patients experienced complications, often
during the interstage period, highlighting the morbidity of this method of
treatment.
Collapse
Affiliation(s)
- Katherine Li
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC 28203, USA
| | - Mario Cuadra
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1320 Scott Ave., Charlotte, NC 28204, USA
| | - Gregory Scarola
- OrthoCarolina Research Institute, Inc., 2001 Vail Ave., Suite 300, Charlotte, NC 28207, USA
| | - Susan Odum
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC 28203, USA.,OrthoCarolina Research Institute, Inc., 2001 Vail Ave., Suite 300, Charlotte, NC 28207, USA
| | - Jesse Otero
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC 28203, USA.,OrthoCarolina Hip and Knee Center, 2001 Vail Ave. Suite 200A, Charlotte, NC 28207, USA
| | - William Griffin
- OrthoCarolina Hip and Knee Center, 2001 Vail Ave. Suite 200A, Charlotte, NC 28207, USA
| | - Bryan D Springer
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC 28203, USA.,OrthoCarolina Hip and Knee Center, 2001 Vail Ave. Suite 200A, Charlotte, NC 28207, USA
| |
Collapse
|
10
|
Fehring TK, Fehring KA, Hewlett A, Higuera CA, Otero JE, Tande AJ. What's New in Musculoskeletal Infection. J Bone Joint Surg Am 2021; 103:1251-1258. [PMID: 34048412 DOI: 10.2106/jbjs.21.00311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Thomas K Fehring
- OrthoCarolina Hip & Knee Center, Charlotte, North Carolina.,Atrium Musculoskeletal Institute, Charlotte, North Carolina
| | | | | | | | - Jesse E Otero
- OrthoCarolina Hip & Knee Center, Charlotte, North Carolina.,Atrium Musculoskeletal Institute, Charlotte, North Carolina
| | | |
Collapse
|