Two-Stage Exchange Arthroplasty for Periprosthetic Shoulder Infection Is Associated with High Rate of Failure to Reimplant and Mortality

Background: Patients with a periprosthetic joint infection (PJI) of the shoulder, who fail to undergo reimplantation in an attempted two-stage exchange seem to be neglected in the current literature. The aim of this study was to assess the clinical course of patients after the first stage in the process of an attempted two-stage exchange for shoulder PJI. Methods: After a retrospective review of our institutional database between 2008 and 2018, 49 patients, who were treated with an intended two-stage exchange for shoulder PJI, were identified. Patients’ demographics, laboratory and health status parameters, along with records of clinical outcome were collected. The primary outcome measurements analyzed were infection eradication, successful reimplantation, and patient survival. Results: Reimplantation was completed in only 35 (71%) of 49 cases and eradication of infection was achieved in 85.7% of patients with successful reimplantation after a mean follow-up duration of 5.1 years (1.1 to 10.2 years). Reasons for failure to reimplant were premature death in 36%, high general morbidity in 29%, satisfaction with the current status in 21%, or severe infection with poor bone and soft tissues in 14% of the patients. Of the 14 cases without reimplantation, eradication rate of infection was 57% after a mean follow-up of 5 years (2.6 to 11 years). The overall mortality rate of the entire cohort was 25% at the latest follow-up and 10% within ninety days after implant removal. Patients who deceased or did not undergo reimplantation during the follow-up were significantly older and had a significantly higher Charlson comorbidity index (CCI). Conclusions: While the two-stage exchange arthroplasty can lead to high rates of infection eradication, a considerable subset of patients never undergoes the second stage for a variety of reasons. Shoulder PJI and its treatment are associated with a high risk of mortality, especially in patients with older age and higher CCI.

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Repeat two-stage exchange arthroplasty for recurrent periprosthetic hip or knee infection: what are the chances for success?

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04330-z ◽

2022 ◽

Author(s):

A. C. Steinicke ◽

J. Schwarze ◽

G. Gosheger ◽

B. Moellenbeck ◽

T. Ackmann ◽

...

Keyword(s):

Risk Factors ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Rank Test ◽

Success Rates ◽

Two Stage ◽

Second Stage ◽

Exchange Arthroplasty ◽

Parametric Testing

Abstract Introduction Two-stage revision is a frequently chosen approach to treat chronic periprosthetic joint infection (PJI). However, management of recurrent infection after a two-stage exchange remains debated and the outcome of a repeat two-stage procedure is unclear. This study investigates the success rates of repeat two-stage exchange arthroplasty and analyzes possible risk factors for failure. Materials and methods We retrospectively identified 55 patients (23 hips, 32 knees) who were treated with repeat resection arthroplasty and planned delayed reimplantation for recurrent periprosthetic joint infection between 2010 and 2019 after a prior two-stage revision at the same institution. The minimum follow-up was 12 months with a median follow-up time of 34 months (IQR 22–51). The infection-free survival, associated revision surgeries, and potential risk factors for further revision were analyzed using Kaplan–Meier survival curves and comparative non-parametric testing. Results 78% (43/55) underwent reimplantation after a repeat implant removal. Of those who completed the second-stage surgery, 37% (16/43) underwent additional revision for infection and 14% (6/55) underwent amputation. The reinfection-free implant survivorship amounted to 77% (95% CI 64–89%) after 1 year and 38% (95% CI 18–57%) after 5 years. Patients with a higher comorbidity score were less likely to undergo second-stage reimplantation (median 5 vs. 3, p = 0.034). Furthermore, obese patients (p = 0.026, Fisher’s exact test) and diabetics (p < 0.001, log-rank test) had a higher risk for further infection. Most commonly cultures yielded polymicrobial growth at the repeat two-stage exchange (27%, 15/55) and at re-reinfection (32%, 9/28). Pathogen persistence was observed in 21% (6/28) of re-reinfected patients. Conclusion The success rates after repeat two-stage exchange arthroplasty are low. Patients must be counseled accordingly and different modes of treatment should be considered.

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High rate of infection eradication following cementless one-stage revision hip arthroplasty with an antibacterial hydrogel coating

The International Journal of Artificial Organs ◽

10.1177/0391398821995507 ◽

2021 ◽

pp. 039139882199550

Author(s):

Antonio Pellegrini ◽

Claudio Legnani

Keyword(s):

Hip Arthroplasty ◽

Soft Tissues ◽

High Rate ◽

Revision Hip Arthroplasty ◽

Harris Hip Score ◽

X Rays ◽

One Stage ◽

Infection Eradication ◽

Hydrogel Coating

Purpose: We conducted a retrospective study to evaluate the outcomes of one-stage revision total hip arthroplasty (THA) following periprosthetic joint infection (PJI) in terms of eradication of the infection, improvement of pain and joint function. We hypothesized that this treatment strategy could lead to satisfying results in selected patients after preoperative microorganism isolation. Methods: Ten patients underwent cementless one-stage revision hip arthroplasty with antibacterial hydrogel coating for the treatment of an infected THA. Inclusion criteria were: the presence of a known organism with known sensitivity, patients non-immunocompromised with healthy soft tissues with minimal or moderate bone loss. Mean age at surgery was 69.4 years. Assessment included objective examination, Harris hip score, visual analog scale pain score, standard X-rays. Results: At a mean follow-up of 3.1 years (range, 2–5 years), none of the patients had clinical or radiographic signs suggesting recurrent infection. Follow-up examination showed significant improvement of all variables compared to pre-operative values ( p < 0.05). Radiographs did not show progressive radiolucent lines or change in the position of the implant. Conclusions: One-stage revision THA with antibacterial hydrogel coated implants represents a safe and effective procedure providing infection eradication and satisfying subjective functional outcomes in selected patients.

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Two-stage exchange Arthroplasty for knee Periprosthetic joint infection exhibit high infection recurrence rate in patients with chronic viral hepatitis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04416-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jui-ping Chen ◽

Chih-hsiang Chang ◽

Yu-chih Lin ◽

Sheng-hsun Lee ◽

Hsin-nung Shih ◽

...

Keyword(s):

Chronic Hepatitis ◽

Viral Hepatitis ◽

Recurrence Rate ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Chronic Viral Hepatitis ◽

Two Stage ◽

Exchange Arthroplasty ◽

Infection Recurrence

Abstract Background Currently, there is little evidence about the outcome of two-stage exchange arthroplasty for the treatment of knee periprosthetic joint infection (PJI) in patients with chronic viral hepatitis. To evaluate it, we set the primary outcome as infection recurrence, and the secondary outcome as the difference between patients diagnosed with hepatitis B virus or hepatitis C virus. Patients and methods Between June, 2010 and December, 2016, 172 patients with knee PJIs were treated with two-stage exchange arthroplasty at our institute. Treatment success was defined using Delphi-based consensus. These patients were further divided into groups with or without chronic hepatitis. Variables were analyzed, including age, sex, comorbidities, microbiology, and operative methods. Minimum follow-up was 12 months (mean, 35 months; range, 12-85 months). Results Of the 172 knee PJI patients, 25 were identified with chronic hepatitis. The infection recurrence rate in the hepatitis group (28%, 7 in 25) was significantly higher than that in the non-hepatitis group (9.5%, 14 in 147), p = 0.017. However, there was no significant difference in the infection recurrence rates between patients with HBV (24%, 4 in 16) and HCV (33.3%, 3 in 9). Regarding the outcomes of patients with infection recurrence, 4 of the non-hepatitis patients were treated with the debridement, antibiotic treatment, irrigation, and retention of prosthesis (DAIR) procedure, with a success rate of 75%. The other 17 patients (7 with hepatitis and 10 without) were treated with repeated two-stage exchange arthroplasty with 100% infection elimination rate until the final follow-up. Conclusions Knee PJI patients with chronic hepatitis have higher infection recurrence rate after two-stage exchange arthroplasty (28%).

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Repeat two-stage exchange arthroplasty for prosthetic hip re-infection

The Bone & Joint Journal ◽

10.1302/0301-620x.100b9.bjj-2018-0470.r1 ◽

2018 ◽

Vol 100-B (9) ◽

pp. 1157-1161 ◽

Cited By ~ 13

Author(s):

T. S. Brown ◽

K. A. Fehring ◽

M. Ollivier ◽

T. M. Mabry ◽

A. D. Hanssen ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Hip Arthroplasty ◽

Joint Infection ◽

Recurrent Infection ◽

High Rate ◽

Two Stage ◽

Musculoskeletal Infection ◽

Exchange Arthroplasty ◽

Prosthetic Joint

Aims Recurrent infection following two-stage revision total hip arthroplasty (THA) for prosthetic joint infection (PJI) is a devastating complication. The purpose of this study was to report the survival of repeat two-stage revision hip arthroplasty, describe complications, and identify risk factors for failure. Patients and Methods We retrospectively identified 19 hips (19 patients) that had undergone repeat two-stage revision THA for infection between 2000 to 2013. There were seven female patients (37%) and the mean age was 60 years (30 to 85). Survival free from revision was assessed via Kaplan–Meier analysis. The patients were classified according to the Musculoskeletal Infection Society (MSIS) system, and risk factors for failure were identified. Mean follow-up was four years (2 to 11). Results Gram-positive bacteria were responsible for 16/17 (94%) of the re-infections where microbes were identified. Following the repeat two-stage exchange arthroplasty, survival free from any revision was 74% (95% confidence interval (CI) 56% to 96%, 14 at risk) at two years and 45% (95% CI 25% to 75%, five at risk) at five years. Failure to control infection resulted in re-operation or revision in 42%A of patients (8/19). Survival free from revision was not dependent on host grade. Conclusion Re-infection after two-stage exchange hip arthroplasty for PJI presents a challenging scenario. Repeat two-stage exchange arthroplasty has a low survival free from revision at five years (45%) and a high rate of re-infection (42%). Cite this article: Bone Joint J 2018;100-B:1157–61.

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Two-Stage Exchange Arthroplasty Is a Favorable Treatment Option Upon Diagnosis of a Fungal Periprosthetic Joint Infection

The Journal of Arthroplasty ◽

10.1016/j.arth.2018.07.024 ◽

2018 ◽

Vol 33 (11) ◽

pp. 3555-3560 ◽

Cited By ~ 6

Author(s):

Feng-Chih Kuo ◽

Karan Goswami ◽

Noam Shohat ◽

Kier Blevins ◽

Alexander J. Rondon ◽

...

Keyword(s):

Treatment Option ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Two Stage ◽

Exchange Arthroplasty

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Two-stage revision arthroplasty in the treatment of periprosthetic hip infections with severe bone loss: Results from 182 cases

Orthopedic Reviews ◽

10.4081/or.2020.8545 ◽

2020 ◽

Vol 12 (2) ◽

Author(s):

Jerzy Białecki ◽

Maciej Kogut ◽

Sławomir Chaberek ◽

Paweł Bartosz ◽

Marcin Obrębski ◽

...

Keyword(s):

Bone Loss ◽

Joint Infection ◽

Revision Arthroplasty ◽

Bone Defects ◽

Harris Hip Score ◽

Two Stage ◽

Retrospective Assessment ◽

Severe Bone Loss ◽

Paprosky Classification

The optimum treatment for periprosthetic joint infection (PJI) of the hip with substantial bone defects remains controversial. A retrospective assessment was performed for 182 patients treated for PJI with a two-stage protocol from 2005 to 2015. Implant removal and debridement were followed by Girdlestone arthroplasty or spacer implantation. The results of the Girdlestone and spacer groups were compared. There were 71 cases that received spacers, and 111 Girdlestone procedures were performed. After the first stage, 26.37% of cultures were negative, and among patients with a detected pathogen, methicillin-sensitive Staphylococcus aureus was the most common organism (41.79%). Acetabular and femoral bone defects, according to the Paprosky classification, were more severe in the Girdlestone group (P<0.05). During the follow-up (mean, 5.95 years), the overall incidence of complications was 21.42%. The mean Harris hip score was significantly lower in the Girdlestone group (68.39 vs 77.79; P<0.0001). The infection recurrence rate reached 8.79%. Despite satisfactory infection control, the number of complications and poor functional outcomes associated with resection arthroplasty indicate the necessity for development of different approaches for patients with advanced bone loss.

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Increased Postoperative Glucose Variability Is Associated With Adverse Outcome Following Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection

The Journal of Arthroplasty ◽

10.1016/j.arth.2019.11.046 ◽

2020 ◽

Vol 35 (5) ◽

pp. 1368-1373

Author(s):

Sheng-Hao Wang ◽

Chi Xu ◽

Timothy L. Tan ◽

Karan Goswami ◽

Alexus M. Cooper ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Adverse Outcome ◽

Joint Infection ◽

Glucose Variability ◽

Two Stage ◽

Exchange Arthroplasty

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Outcomes of repeat two-stage exchange hip arthroplasty for prosthetic joint infection

The Bone & Joint Journal ◽

10.1302/0301-620x.101b6.bjj-2018-1556.r1 ◽

2019 ◽

Vol 101-B (6_Supple_B) ◽

pp. 110-115 ◽

Cited By ~ 10

Author(s):

N. Khan ◽

D. Parmar ◽

M. S. Ibrahim ◽

B. Kayani ◽

F. S. Haddad

Keyword(s):

Hip Arthroplasty ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Antimicrobial Treatment ◽

Successful Outcome ◽

Two Stage ◽

Persistent Symptoms ◽

Prosthetic Joint ◽

Revision Tha

Aims The increasing infection burden after total hip arthroplasty (THA) has seen a rise in the use of two-stage exchange arthroplasty and the use of increasingly powerful antibiotics at the time of this procedure. As a result, there has been an increase in the number of failed two-stage revisions during the past decade. The aim of this study was to clarify the outcome of repeat two-stage revision THA following a failed two-stage exchange due to recurrent prosthetic joint infection (PJI). Patients and Methods We identified 42 patients who underwent a two-stage revision THA having already undergone at least one previous two stage procedure for infection, between 2000 and 2015. There were 23 women and 19 men. Their mean age was 69.3 years (48 to 81). The outcome was analyzed at a minimum follow-up of two years. Results A satisfactory control of infection and successful outcome was seen in 26 patients (57%). There therefore remained persistent symptoms that either required further surgery or chronic antibiotic suppression in 16 patients (38%). One-third of patients had died by the time of two years’ follow-up. Conclusion The rate of failure and complication rate of repeat two-stage exchange THA for PJI is high and new methods of treatment including host optimization, immunomodulation, longer periods between stages, and new and more powerful forms of antimicrobial treatment should be investigated. Cite this article: Bone Joint J 2019;101-B(6 Supple B):110–115.

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