Abstract
PurposeThe aim of this study was the evaluation of possible outcome differences of patients undergoing two-stage hip exchange with antibiotic-loaded spacers, compared to patients without an interim spacer implantation.MethodsWe evaluated 46 patients undergoing two-stage hip revision surgery. Twenty-five patients received an interim ALS. Additional to a Kaplan–Meier survival analysis, a competing risk analysis was performed to estimate the cumulative incidence function for re-revisions due to infection accounting for death as a competing event.ResultsNine patients (seven non-ALS vs. two ALS) had to undergo re-revision surgery due to reinfection of the hip joint. The non-ALS group showed a risk of re-revision of 19% (95% CI 5–38%) at 12 and 24 months and 30% (95% CI 12–51%) at 36 months. The group with ALS implantation displayed a 0% risk of re-revision surgery in the first 36 months. The Gray test revealed a significant difference in the cumulative incidence between both observed groups (p = 0.026).ConclusionOur findings suggest that ALS implantation significantly reduces the risk of reinfection after two-stage hip revision surgery.
Highlights
Periprosthetic joint infection (PJI) is one of the most demanding complications after total hip arthroplasty (THA), it has a vast impact on patient’s morbidity and mortality, and remains a socio-economic problem [1,2,3,4]
antibiotic-loaded cement spacer (ALS) may contribute to the eradication of a PJI, as ALS improves the antimicrobial efficacy of systemic antibiotics [12]
We performed a retrospective study of patients suffering from a deep infection after total hip arthroplasty (THA) between 2001 and 2014 using the hospital database
Summary
Periprosthetic joint infection (PJI) is one of the most demanding complications after total hip arthroplasty (THA), it has a vast impact on patient’s morbidity and mortality, and remains a socio-economic problem [1,2,3,4]. The best therapeutic strategy for PJI still remains open to widespread debate [1, 5,6,7,8,9]. Two-stage revisions show satisfying success rates, at around 90%, and represent the standard procedure especially for late/chronic infections [6, 9, 10]. During the first-stage procedure, the infected prosthesis is removed and an implantation of an interim antibiotic-loaded cement spacer (ALS) can be considered. The major advantage of the usage of ALS is the possibility of maintaining high antibiotic concentrations that reach a local therapeutic level [11]. An additional benefit may be the avoidance of possible contractures through the reduction of the dead space after explantation of the infected implants [6, 13]
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