Surgical Management of Periprosthetic Joint Infection: One-Stage Exchange

Aims One-stage exchange for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) is gaining popularity. The outcome for a repeat one-stage revision THA after a failed one-stage exchange for infection remains unknown. The aim of this study was to report the infection-free and all-cause revision-free survival of repeat one-stage exchange, and to investigate the association between the Musculoskeletal Infection Society (MSIS) staging system and further infection-related failure. Methods We retrospectively reviewed all repeat one-stage revision THAs performed after failed one-stage exchange THA for infection between January 2008 and December 2016. The final cohort included 32 patients. The mean follow-up after repeat one-stage exchange was 5.3 years (1.2 to 13.0). The patients with a further infection-related failure and/or all-cause revision were reported, and Kaplan-Meier survival for these endpoints determined. Patients were categorized according to the MSIS system, and its association with further infection was analyzed. Results A total of eight repeat septic revisions (25%) developed a further infection-related failure, and the five-year infection-free survival was 81% (95% confidence interval (CI) 57 to 92). Nine (28%) underwent a further all-cause revision and the five-year all-cause revision-free survival was 74% (95% CI 52 to 88). Neither the MSIS classification of the host status (p = 0.423) nor the limb status (p = 0.366) was significantly associated with further infection-related failure. Conclusion Repeat one-stage exchange for PJI in THA is associated with a favourable five-year infection-free and all-cause revision-free survival. Notably, the rate of infection control is encouraging when compared with the reported rates after repeat two-stage exchange. The results can be used to counsel patients and help clinicians make informed decisions about treatment. With the available number of patients, further infection-related failure was not associated with the MSIS host or limb status. Cite this article: Bone Joint J 2022;104-B(1):27–33.

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One-Stage Exchange Arthroplasty for Periprosthetic Joint Infection

Periprosthetic Joint Infection: Practical Management Guide ◽

10.5005/jp/books/11779_39 ◽

2013 ◽

pp. 297-297

Author(s):

Erik Hansen

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

One Stage ◽

Exchange Arthroplasty

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What are the Factors Associated with Re-revision After One-stage Revision for Periprosthetic Joint Infection of the Hip? A Case-control Study

Clinical Orthopaedics and Related Research ◽

10.1097/corr.0000000000000780 ◽

2019 ◽

Vol 477 (10) ◽

pp. 2258-2263 ◽

Cited By ~ 9

Author(s):

Hussein Abdelaziz ◽

Hendrik Grüber ◽

Thorsten Gehrke ◽

Jochen Salber ◽

Mustafa Citak

Keyword(s):

Periprosthetic Joint Infection ◽

Case Control Study ◽

Joint Infection ◽

Case Control ◽

Factors Associated ◽

One Stage ◽

Control Study

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High re-revision rate following one-stage exchange for streptococcal periprosthetic joint infection of the hip

Hip International ◽

10.1177/1120700021991467 ◽

2021 ◽

pp. 112070002199146

Author(s):

Malte Ohlmeier ◽

Insa Jachczik ◽

Mustafa Citak ◽

Thorsten Gehrke ◽

Nael Hawi ◽

...

Keyword(s):

Postoperative Complications ◽

Periprosthetic Joint Infection ◽

Comparative Studies ◽

Streptococcal Infection ◽

Revision Rate ◽

Joint Infection ◽

Harris Hip Score ◽

One Stage ◽

The Mean

Introduction: This study was undertaken to analyse the outcome of 1-stage exchange in the management of streptococcal periprosthetic joint infection (PJI) of the hip at a single hospital. Methods: We identified 30 patients with a streptococcal PJI of the hip who had been treated by 1-stage exchange at our hospital between 2002 and 2017. Postoperative complications and the need for any subsequent re-revision for infection or other reasons were analysed. The Harris Hip Score (HHS) was evaluated at final follow-up. Results: The mean follow-up was 8.2 years (SD 4.1). The overall re-revision rate for any reason was 53% (16/30) at a mean 5.3 years (SD 0.68 years). Re-revision for infection was 20% (6/30) at a mean 1.8 years (SD 0.74 years). All re-revisions for PJI (6/6; 100%) were for relapse of the streptococcal infection. At final follow-up, the mean HHS was 68 points (SD 20). Conclusions: The rate of re-revision after 1-stage exchange for streptococcal PJI is high. Eradication of a streptococcal PJI of the hip remains challenging. Further extensive and comparative studies between 1-and 2-stage exchange are encouraged.

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Efficiency of the One-Stage Revision Hip Arthroplasty in Chronic Periprosthetic Joint Infection with Sinus Tract

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2021-27-2-9-22 ◽

2021 ◽

Vol 27 (2) ◽

pp. 9-22

Author(s):

V. A. Artyukh ◽

S. A. Bozhkova ◽

A. A. Boyarov ◽

Ju. V. Muravyova ◽

A. A. Kochish

Keyword(s):

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Soft Tissues ◽

Joint Infection ◽

Sinus Tract ◽

Revision Hip Arthroplasty ◽

One Stage ◽

Significant Difference ◽

The One

Background. Chronic periprosthetic joint infection (PJI) remains the one among the most severe complications of total hip arthroplasty. Presence of sinus tract assosiated with polymicrobial infection development, complexity of bacteriological diagnostics and damage of soft tissues lead to constrictions of one-stage revision hip arthroplasty (RHA). The aim of this studywas to assess the influence of draining sinus tract on the outcomes of one-stage RHA in patients with chronic hip PJI.Materials and Methods.A prospective cohort comparative study included 78 patients who underwent one-stage RHA in 2017-2020. Two groups were formed: 48 (61.54%) patients without sinus tract (WST) and 30 (38.45%) patients with sinus tract (ST).Results. The presence of a sinus tract significantly increased the duration of a one-stage RHA in groups of ST and WST (230 and 197.5 min respectively, p = 0.02), as well as blood loss (850 ml and 700 ml, respectively, p = 0.046). Sinus tract was a reliable symptom of soft tissue local infectious inflammation (86.67%, p = 0.00031), fasciitis (36.67%, p = 0.012), purulent cavity (66.67%, p = 0.00027). The structure of the pathogens was comparable. Monobacterial infections predominated in the WST group (82.98%) and in the ST group (77.78%, p = 0.08). In most cases staphylococci were isolated. The median follow-up was 20 months for both groups. The PJI was healed in 93.0% (n = 28) patients in WST group and 82.2% (n = 43) in ST PJI (p>0.05). Postoperative evaluation in the WST and ST groups: HHS 92 and 90 points (p = 0.79), EQ-5D-5L – 0.82 and 0.78 points (p = 0.84) respectively. The proportion of patients who were indicated revision surgery with no PJI association in the ST group exceeded this indicator more than twice according to the WST group — 25 and 11.62%, respectively (p>0.05).Conclusion.As a result of the study, there was no statistically significant difference between the outcomes of one-stage RHA in patients with and without sinus tract. Factors such as the anamnesis morbi, the soft tissues condition at the surgical site and the pathogenic microflora characteristics should be taken into account in order to achieve favourable outcomes of surgical treatment.

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Is two-stage revision surgery for infected hip arthroplasty worth the suffering, resources and results compared to one-stage?

Hip International ◽

10.1177/1120700020949162 ◽

2020 ◽

pp. 112070002094916

Author(s):

Dimitrios Sotiriou ◽

Hampus Stigbrand ◽

Gösta Ullmark

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Hospital Stay ◽

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Bone Grafting ◽

Joint Infection ◽

Impaction Bone Grafting ◽

One Stage

Purpose: Periprosthetic joint infection (PJI) is the most serious complication of total hip arthroplasty. The treatment is usually revision in either 1 or 2 stages. This study analyses revision with impaction bone grafting for periprosthetic joint infection of the hip and compares 1- and 2-stage strategies. Patients and methods: We reviewed 55 consecutive cases (54 patients) of revision arthroplasty for PJI carried out at our hospital between 2002 and 2016. Of these, 46 were 2-stage procedures. 21 had vancomycin mixed in with the bone graft, and all had gentamycin-containing bone cement. The total perioperative blood loss, duration of operation, and length of hospital stay were recorded. Clinical and radiological results were analysed for 48 hips at 2–16 years follow-up. Results: No PJI remained at follow-up. 3 patients (6%) had undergone revision for all causes. 1 had radiological signs of mechanical loosening but was not revised. 2-stage procedures had a significantly longer operating time (409 vs. 238 min) and hospital stay (34 vs. 13 days), greater blood loss (2764 vs. 1638 ml), and lower mean functional hip score (15.9 vs. 17.5) at follow-up than the one-stage procedures. Interpretation: Revision total hip arthroplasty for PJI with vancomycin-loaded impaction bone grafting is a safe method that achieves both the restoration of bone stock and resolution of the infection. This single-stage procedure could therefore be the new gold standard for treatment of non-complicated PJI in the hip.

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