Abstract
Aims: In cases of a two-stage septic total hip arthroplasty (THA) exchange a femoral osteotomy with subsequent cerclage stabilization may be necessary to remove a well-fixed stem. This study aims to investigate the rate of bacterial colonization and risk of infection persistence associated with in situ cerclage hardware in two-stage septic THA exchange.Patients and Methods: Twenty-three patients undergoing two-stage THA exchange between 2011 and 2016 were included in this retrospective cohort study. During the re-implantation procedure synovial fluid, periprosthetic tissue samples and sonicate fluid cultures (SFC) of the cerclage hardware were acquired.Results: Seven of 23 (30%) cerclage-SFC produced a positive bacterial isolation. Six of the seven positive cerclage-SFC were acquired during THA re-implantation.Two of the seven patients (29%) with a positive bacterial isolation from the cerclage hardware underwent a THA-revision for septic complications. The other five patients had their THA in situ at last follow-up.Conclusions: Despite surgical debridement and antimicrobial therapy, a bacterial colonization of cerclage hardware occurs and poses a risk for infection persistence. All cerclage hardware should be removed or exchanged during THA reimplantation.
Highlights
The main goal of a two stage hip revision in periprosthetic joint infection (PJI) is the elimination of all bacteria and biofilm
Six positive bacterial isolations were from cerclage-sonicate fluid cultures (SFC) during total hip arthroplasty (THA)-reimplantation and one positive isolation was from a cerclage-SFC during a second irrigation and debridement (I&D) procedure
Our data shows that femoral cerclages, implanted during the explantation procedure, represent a risk factor for bacterial colonization and persistence during septic two stage THA exchange
Summary
The main goal of a two stage hip revision in periprosthetic joint infection (PJI) is the elimination of all bacteria and biofilm. In cases of a well-fixed stem or extensive cementation an extended trochanteric osteotomy or an osseous window may be necessary during the explantation procedure in septic cases [3,4,5] In these cases, an osteosynthesis using wire- or band-cerclages becomes necessary to fixate the osteotomy and restore the stability of the proximal femur [4, 5]. An osteosynthesis using wire- or band-cerclages becomes necessary to fixate the osteotomy and restore the stability of the proximal femur [4, 5] This in turn means the introduction of new foreign material in a potentially septic environment. Previous sonication studies were able to show that the bacterial biofilm in PJI encompasses the entire joint and all intraarticular components, independent of component type or material [6,7,8]
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