Abstract
BackgroundSurgeons are often trying to decreased reinfection rates following two-stage reimplantation arthroplasty, which range from 3.2% to 13% because multiple staged revision procedures for infection can be costly and have high morbidity. We therefore asked: (1) Did the use of postoperative oral antibiotics reduce reinfection rates after 2-staged revision of THA? And (2) how did this compare with the infection rate after aseptic revision procedures?MethodsWe identified all patients who underwent two-stage revision THA for a periprosthetic deep hip infection and found 66 patients (67 hips) who had a minimum 24 months’ followup. Twenty-two of the 66 procedures (33%) were followed by a minimum of 14 days of postoperative oral antibiotics (mean, 36 days; range, 14 days to lifelong), while 44 were prescribed only immediate parenteral postoperative antibiotic therapy (mean, 1.3 days; range, 1–3 days). We then identified 407 patients (410 hips) who underwent aseptic revision hip arthroplasty and evaluated the infection rate in these patients for comparison; these patients were treated with 24 hours of postoperative parenteral antibiotics. The authors used previously described creteria to establish the presence of infection.ResultsThere were no reinfections in the group receiving oral postoperative antibiotics compared to six reinfections (13.6%) in the 44 patients not receiving oral antibiotics. We observed infection in 2 of the 410 hips (0.5%) revised for aseptic reasons.ConclusionsWe believe that our findings warrant further investigation for using postoperative oral antibiotics after reimplantation for periprosthetic infection in an effort to decrease the likelihood and risks associated with additional revision arthroplasty procedures.
Highlights
Surgeons are often trying to decreased reinfection rates following two-stage reimplantation arthroplasty, which range from 3.2% to 13% because multiple staged revision procedures for infection can be costly and have high morbidity
The overall infection rate for primary THA is reportedly less than 1% [4,5,7,8], the reinfection rates after two-stage reimplantation arthroplasty range from 3.2% to 13% [9,10,11,12,13]
We identified numerous organisms on culture at the time of initial explantation, with methicillin-resistant Staphylococcus aureus (MRSA) the most prevalent in both groups (Table 2) (31% in the oral antibiotic group compared to 25% in the group without oral antibiotics [p = 0.5])
Summary
Surgeons are often trying to decreased reinfection rates following two-stage reimplantation arthroplasty, which range from 3.2% to 13% because multiple staged revision procedures for infection can be costly and have high morbidity. We asked: (1) Did the use of postoperative oral antibiotics reduce reinfection rates after 2-staged revision of THA? Treatment methods may depend on the type of infection, surgeon preference, patients’ medical comorbidities, the overall infection rate for primary THA is reportedly less than 1% [4,5,7,8], the reinfection rates after two-stage reimplantation arthroplasty range from 3.2% to 13% [9,10,11,12,13]. There is currently no definitive “gold standard”
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