One-stage revision of infected hip arthroplasty: outcome of 39 consecutive hips

Thomas Ilchmann,Bernhard Kessler,Lukas Zwicky,Peter Graber,Werner Zimmerli,Peter Emil Ochsner,Martin Clauss

doi:10.1007/s00264-015-2833-4

Thomas Ilchmann, Bernhard Kessler + Show 5 more

Open Access

https://doi.org/10.1007/s00264-015-2833-4

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Abstract

There are various options for treating periprosthetic joint infection (PJI). Two-stage exchange has traditionally been the gold standard. However, if the appropriate surgical intervention is chosen according to a rational algorithm, the outcome is similar when using all types of interventions. In an observational cohort study, the outcome of patients with PJI after hip replacement treated with one-stage revision was analysed. All patients fulfilling all criteria for one-stage exchange according to the Infectious Diseases Society of America (IDSA) guidelines and six without preoperative identification of a microorganism were included. Implant removal, debridement and cemented or uncemented reimplantations were performed in a single intervention. If a cemented device was implanted, commercially available gentamicin cement was used in all cases. Antibiotic treatment was administered intravenously for at least 2weeks, followed by oral therapy for a total duration of 3months. Patients had standardised clinical and radiological follow-up visits. Between 1996 and 2011, 38 patients (39 hips) were treated with a one-stage procedure and followed for at least 2years. Coagulase-negative staphylococci were the most frequent pathogens, and polymicrobial infection was observed in five cases. In 25 hips, an uncemented revision stem was implanted, and 37 hips received an acetabular reinforcement ring. The mean follow-up was 6.6 (2.0-15.1) years. No patient had persistent, recurrent or new infection. There were four stem revisions for aseptic loosening. The mean Harris Hip Score was 81 points (26-99) at the final follow-up. Excellent cure rate and function seen in our study suggest that one-stage exchange is a safe procedure, even without local antibiotic treatment, provided that the patient has no sinus tract or severe soft tissue damage, no major bone grafting is required and the microorganism is susceptible to orally administered agents with high bioavailability.

Highlights

Periprosthetic joint infection (PJI) is a major complication after total joint replacement and causes additional surgery, functional impairment and high medical costs
Coagulase-negative staphylococci were the most frequent pathogens, and polymicrobial infection was observed in five cases
Excellent cure rate and function seen in our study suggest that one-stage exchange is a safe procedure, even without local antibiotic treatment, provided that the patient has no sinus tract or severe soft tissue damage, no major bone grafting is required and the microorganism is susceptible to orally administered agents with high bioavailability

Summary

Introduction

Periprosthetic joint infection (PJI) is a major complication after total joint replacement and causes additional surgery, functional impairment and high medical costs. There is an increasing incidence of PJI due to an increasing number of operations and patients at risk living with orthopaedic implants [1]. The diagnostic and therapeutic management of PJI is demanding and expensive. Various treatment options are discussed controversially, and reported case series are difficult to compare with each other. Prospective randomised trials are difficult or even impossible to achieve, and lacking [2].

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