Infection Control Rate of Irrigation and Débridement for Periprosthetic Joint Infection

Aims In the absence of an identified organism, single-stage revision is contraindicated in prosthetic joint infection (PJI). However, no studies have examined the use of intra-articular antibiotics in combination with single-stage revision in these cases. In this study, we present the results of single-stage revision using intra-articular antibiotic infusion for treating culture-negative (CN) PJI. Methods A retrospective analysis between 2009 and 2016 included 51 patients with CN PJI who underwent single-stage revision using intra-articular antibiotic infusion; these were compared with 192 culture-positive (CP) patients. CN patients were treated according to a protocol including intravenous vancomycin and a direct intra-articular infusion of imipenem and vancomycin alternately used in the morning and afternoon. In the CP patients, pathogen-sensitive intravenous (IV) antibiotics were administered for a mean of 16 days (12 to 21), and for resistant cases, additional intra-articular antibiotics were used. The infection healing rate, Harris Hip Score (HHS), and Hospital for Special Surgery (HSS) knee score were compared between CN and CP groups. Results Of 51 CN patients, 46 (90.2%) required no additional medical treatment for recurrent infection at a mean of 53.2 months (24 to 72) of follow-up. Impaired kidney function occurred in two patients, and one patient had a local skin rash. No significant difference in the infection control rate was observed between CN and CP PJIs (90.2% (46/51) versus 94.3% (181/192); p = 0.297). The HHS of the CN group showed no substantial difference from that of CP cases (79 versus 81; p = 0.359). However, the CN group showed a mean HSS inferior to that of the CP group (76 versus 80; p = 0.027). Conclusion Single-stage revision with direct intra-articular antibiotic infusion can be effective in treating CN PJI, and can achieve an infection control rate similar to that in CP patients. However, in view of systemic toxicity, local adverse reactions, and higher costs, additional strong evidence is needed to verify these treatment regimens. Cite this article: Bone Joint J 2020;102-B(3):336–344

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A decision analysis of treatment strategies for acute periprosthetic joint infection: Early irrigation and debridement versus delayed treatment based on organism

Journal of Orthopaedics ◽

10.1016/j.jor.2020.04.003 ◽

2020 ◽

Vol 22 ◽

pp. 246-250

Author(s):

Hany S. Bedair ◽

Akhil Katakam ◽

Yehia H. Bedeir ◽

David Yeroushalmi ◽

Ran Schwarzkopf

Keyword(s):

Decision Analysis ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Treatment Strategies ◽

Delayed Treatment ◽

Irrigation And Debridement

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Quality of life, infection control, and complication rates using a novel custom-made articulating hip spacer during two-stage revision for periprosthetic joint infection

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04274-4 ◽

2021 ◽

Author(s):

Andre Lunz ◽

Georg W. Omlor ◽

Gunter Schmidt ◽

Babak Moradi ◽

Burkhard Lehner ◽

...

Keyword(s):

Infection Control ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Complication Rates ◽

Two Stage ◽

Implant Survivorship ◽

Custom Made ◽

Patient Reported

Abstract Introduction Two-stage revision remains the gold standard treatment for most chronically infected and complex total hip arthroplasty infections. To improve patient outcome and reduce complication rates, we have developed a novel custom-made articulating hip spacer technique and present our short-term results. Materials and methods Between November 2017 and November 2019, 27 patients (mean age 70 years) underwent two-stage revision for periprosthetic joint infection of the hip using the articulating spacer design described here. We retrospectively analyzed spacer-related complications as well as rates for complication, infection control, and implant survivorship after final reimplantation. Furthermore, we prospectively collected patient-reported health-related quality of life (HRQoL) scores prior to spacer implantation, with the spacer and after reimplantation of the new prosthesis. Results An additional round of spacer exchange was performed in two patients (8.3%), persistent wound discharge was the reason in both cases. We had one (4.2%) spacer-related mechanical complication, a dislocation that was treated with closed reduction. After reimplantation, infection control was achieved in 96% with an implant survivorship of 92% after a mean follow-up time of 19 (range 7–32, SD 7.2) months. While the scores for VR-12 MCS, VAS hip pain and patient-reported overall satisfaction significantly improved after first stage surgery, the scores for WOMAC, UCLA and VR-12 PCS significantly improved after second stage surgery. Conclusions Our two-stage approach for periprosthetic joint infection shows high infection eradication and implant survivorship rates at short-term follow-up. Spacer-related complication rates were low, and we achieved high patient satisfaction rates and low pain levels already during the spacer period. To further simplify comparison between different spacer designs, we propose a new hip spacer classification system.

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In Vitro Activity of Rifampin, Rifabutin, and Rifapentine against Enterococci and Streptococci from Periprosthetic Joint Infection

Microbiology Spectrum ◽

10.1128/spectrum.00071-21 ◽

2021 ◽

Author(s):

Mariana Albano ◽

Melissa J. Karau ◽

Kerryl E. Greenwood-Quaintance ◽

Douglas R. Osmon ◽

Caitlin P. Oravec ◽

...

Keyword(s):

Drug Interactions ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Vitro Activity ◽

In Vitro Activity ◽

Irrigation And Debridement ◽

To Receive

Rifampin is an antibiotic with antistaphylococcal biofilm activity used in the management of staphylococcal periprosthetic joint infection with irrigation and debridement with component retention; some patients are unable to receive rifampin due to drug interactions or intolerance. We recently showed rifabutin and rifapentine to have in vitro activity against planktonic and biofilm states of rifampin-susceptible periprosthetic joint infection-associated staphylococci.

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