Early onset prosthetic hip and knee joint infection: treatment and outcomes in Victoria, Australia

Abstract

Prosthetic joint infection (PJI) remains a devastating complication of arthroplasty. There are no internationally endorsed consensus management guidelines and treatment approaches differ widely. The aim of this multicentre study was to examine treatment approaches and predictors of treatment failure in patients with early PJI managed in hospitals in Victoria, Australia. This cohort study was conducted across 10 hospitals over a three-year period (January 2006 to December 2008) and involved 147 patients who presented with early PJI. Most patients (76%) were managed with debridement and retention of the prosthesis. Patients were followed for a median 20 months (interquartile range: 7-36). Overall 43 patients experienced treatment failure with a 12-month infection-free survival estimate of 76% [95% confidence interval (CI): 68-83%]. The following factors were associated with treatment failure: septic revision arthroplasty (hazard ratio: 7.5; 95% CI: 2.4-23.1; P < 0.0001), hypotension at presentation (4.9; 1.5-15.7; P = 0.007), one-stage exchange (3.1; 1.0-9.2; P = 0.048), total duration of antibiotic therapy <90 days: specifically <30 days (18.5; 5.4-63.1; P < 0.001), 30-60 days (8.0; 2.6-23.9; P < 0.001) and 60-90 days (7.3; 2.2-24.4; P = 0.001), respectively. Effective empiric antibiotic therapy was associated with a decreased risk of treatment failure (0.20; 0.09-0.47; P < 0.001). The management approach in Australia differs from that used elsewhere in the world. We have identified a number of clinically relevant risk factors for treatment failure that may impact on treatment recommendations.