Differential microbiological spectrum and resistance pattern in periprosthetic hip joint infections: a matched-cohort analysis comparing direct anterior versus lateral approach

Alexander Aichmair,Sebastian Simon,Gabriel Singer,Jochen G Hofstaetter,Martin Dominkus,Bernhard J H Frank

doi:10.1186/s12891-022-05037-x

Alexander Aichmair, Sebastian Simon + Show 4 more

Open Access

https://doi.org/10.1186/s12891-022-05037-x

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Abstract

BackgroundIn recent years, total hip arthroplasty via the direct anterior approach (DAA) has become more common. Little is known on the influence of the surgical approach on the microbiological spectrum and resistance pattern in periprosthetic hip joint infections. The aim of the present study was to evaluate the microbiological spectrum and resistance pattern in periprosthetic hip joint infections comparing the direct anterior versus lateral approach in a matched-cohort analysis at a single institution.MethodsPatients who underwent revision hip arthroplasty due to PJI following primary total hip arthroplasty with culture positive microbiology were analyzed. In all study patients, both the primary surgery and the revisions surgery were performed at the same institution. Only patients in whom primary surgery was performed via a direct anterior or lateral approach were included (n = 87). A matched cohort analysis was performed to compare the microbiological spectrum and resistance pattern in PJI following direct anterior (n = 36) versus lateral (n = 36) primary THA.ResultsWe identified both a significantly different microbiological spectrum and resistance pattern in PJI comparing direct anterior versus lateral approach THA. Cutibacterium avidum was obtained more frequently in the anterior subgroup (22.2% vs. 2.8%, p = 0.028). In the subgroup of infections with Staphylococcus aureus (n = 12), methicillin resistance was detected in 3/5 cases in the direct anterior group versus 0/7 cases in the lateral group (p = 0.045). Overall, Staphylococcus epidermidis was the most common causative microorganism in both groups (direct anterior: 36.1%; lateral: 27.8%, p = 0.448).ConclusionThe present study indicates a potential influence of the localization of the skin incision in THA on the microbiological spectrum and resistance pattern in PJI. Cutibacterium avidum seemed to be a more common causative microorganism in PJI in patients who underwent direct anterior compared to lateral approach THA.

Highlights

IntroductionTotal hip arthroplasty via the direct anterior approach (DAA) has become more common
In recent years, total hip arthroplasty via the direct anterior approach (DAA) has become more common
While Ilchmann et al identified no increased risk of infection for the DAA versus the lateral approach [12], Aggarwal et al reported on a higher rate of Periprosthetic joint infections (PJI) in patients who underwent DAA THA compared to other surgical approaches in an analysis of 6086 cases [13]

Summary

Introduction

Total hip arthroplasty via the direct anterior approach (DAA) has become more common. Little is known on the influence of the surgical approach on the microbiological spectrum and resistance pattern in periprosthetic hip joint infections. The aim of the present study was to evaluate the microbiological spectrum and resistance pattern in periprosthetic hip joint infections comparing the direct anterior versus lateral approach in a matched-cohort analysis at a single institution. There are antithetic results regarding the risk of PJI following direct anterior THA compared to other approaches [9,10,11,12,13]. While Ilchmann et al identified no increased risk of infection for the DAA versus the lateral approach [12], Aggarwal et al reported on a higher rate of PJI in patients who underwent DAA THA compared to other surgical approaches in an analysis of 6086 cases [13]. Prior studies have identified an inferior outcome in the setting of polymicrobial infections [14] and multi-drug resistant microorganisms [15]

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