Abstract
The purpose of this study was to evaluate patients requiring in-patient care due to a periprosthetic joint infection (PJI), with respect to bacterial agents, surgical treatment, antibiotics, and outcome. We retrospectively identified all infected total hip arthroplasties (THAs) in a Swedish regional hospital during a 7-year period (2012–2018) and reviewed medical records and microbiological data. A total of 89 infected THAs in 87 patients were identified. Standardized treatment with debridement with retention of the implant and antibiotics (DAIR) was initially performed in 53 cases (60 %), one or two stage revisions in 33 cases (37 %), and an immediate Girdlestone in 3 cases (3 %). Infection eradication was seen in 77 PJIs (87 %) in addition to six patients (7 %) ending up with a permanent but uninfected Girdlestone. All six patients with manifest failures were infected with Staphylococcus aureus, two of which were also polymicrobial. Cutibacterium acnes was found in 18 of 89 patients (16 %) distributed in 15 uncemented implants but only in 3 hybrids and cemented arthroplasties, while remaining pathogens were equally distributed in uncemented THAs () and THAs with at least one cemented component (; ). Eradication was achieved in all 18 patients when Cutibacterium acnes was the only culture () or clearly dominant among positive cultures (). DAIR was successful in selected postoperative infections up to 6 months after hip replacement. Cutibacterium acnes infections in hip arthroplasty may be underdiagnosed. Cemented components in THAs seem to protect from colonization with Cutibacterium acnes.
Highlights
Periprosthetic joint infection (PJI) is a feared and serious complication of prosthetic surgery, which causes great suffering for the individual and requires major healthcare resources
The number of PJI episodes was relatively small and, like in other observational studies, this creates a risk that the diversity of both the patient populations and the treatment strategies cause inconsistent recommendations despite our best efforts
A majority of the failures in our study cohort (83 %) were associated with PJIs caused by Staphylococcus aureus, which is known as a potent biofilm producer and is often difficult to eradicate (Moormeier and Bayles, 2017; Sendi et al, 2017)
Summary
Periprosthetic joint infection (PJI) is a feared and serious complication of prosthetic surgery, which causes great suffering for the individual and requires major healthcare resources. The incidence in primary interventions is 0.5 %– 2 %, higher for revision procedures (Engesaeter et al, 2011), and seems to be increasing both worldwide (Kurtz et al, 2012) and in Scandinavia (Dale et al, 2012). Antibiotic treatment alone is insufficient to eradicate and cure infection (Sendi et al, 2017; Zimmerli et al, 2004). When performed as a twostage procedure, results in substantial morbidity, loss of ambulation, and decreased quality of life (Leonard et al, 2014). Debridement, antibiotics, and implant retention (DAIR) of well fixated implants has gained increased popularity in an international context due to both increased cure rates and patient preference. Various treatment protocols, insufficient detection of causative bacterial agents, limited surgical accuracy, and inconsistent follow-up
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