scholarly journals One-Stage Hip Revision Arthroplasty Using Megaprosthesis in Severe Bone Loss of The Proximal Femur Due to Radiological Diffuse Osteomyelitis

2021 ◽  
Vol 7 (1) ◽  
pp. 5
Author(s):  
Roy Gonzalez ◽  
Ernesto Muñoz-Mahamud ◽  
Guillem Bori
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Positive Culture ◽  
Bone Defects ◽  
Cement Spacer ◽  
One Stage ◽  
Exchange Arthroplasty ◽  
Severe Bone Loss

Managing substantial proximal and/or distal femoral bone defects is one of the biggest challenges in chronic hip periprosthetic joint infection. Most authors use two-stage arthroplasty with a temporary antibiotic-loaded cement spacer for the management of these patients. In this study, we show our experience with one-stage exchange arthroplasty in managing severe bone defects due to radiological-extensive proximal femoral osteomyelitis. Two patients were included in the study. They showed radiological-extensive proximal femoral osteomyelitis, and they were treated with one-stage exchange arthroplasty using megaprosthesis. Diffuse osteomyelitis was confirmed in both cases; in one case, the histology was compatible with osteomyelitis, and the other case had a positive culture identified in a bone sample. At a minimum of a four-year follow-up, the patients did not reveal any clinical, radiological or laboratory signs of infection. In conclusion, one-stage exchange arthroplasty and megaprosthesis is an option for the treatment of chronic hip periprosthetic joint infection associated with radiological-diffuse proximal femoral osteomyelitis.

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

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.

One-stage revision is as effective as two-stage revision for chronic culture-negative periprosthetic joint infection after total hip and knee arthroplasty

2021 ◽  
pp. 1-7
Author(s):  
Janna van den Kieboom ◽  
Venkatsaiakhil Tirumala ◽  
Hayden Box ◽  
Ruben Oganesyan ◽  
Christian Klemt ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Randomized Study ◽  
Treatment Strategies ◽  
Revision Arthroplasty ◽  
Two Stage ◽  
One Stage ◽  
Hip And Knee Arthroplasty ◽  
Culture Negative

Aims Removal of infected components and culture-directed antibiotics are important for the successful treatment of chronic periprosthetic joint infection (PJI). However, as many as 27% of chronic PJI patients yield negative culture results. Although culture negativity has been thought of as a contraindication to one-stage revision, data supporting this assertion are limited. The aim of our study was to report on the clinical outcomes for one-stage and two-stage exchange arthroplasty performed in patients with chronic culture-negative PJI. Methods A total of 105 consecutive patients who underwent revision arthroplasty for chronic culture-negative PJI were retrospectively evaluated. One-stage revision arthroplasty was performed in 30 patients, while 75 patients underwent two-stage exchange, with a minimum of one year's follow-up. Reinfection, re-revision for septic and aseptic reasons, amputation, readmission, mortality, and length of stay were compared between the two treatment strategies. Results The patient demographic characteristics did not differ significantly between the groups. At a mean follow-up of 4.2 years, the treatment failure for reinfection for one-stage and two-stage revision was five (16.7%) and 15 patients (20.0%) (p = 0.691), and for septic re-revision was four (13.3%) and 11 patients (14.7%) (p = 0.863), respectively. No significant differences were observed between one-stage and two-stage revision for 30- 60- and 90-day readmissions (10.0% vs 8.0%; p = 0.714; 16.7% vs 9.3%; p = 0.325; and 26.7% vs 10.7%; p = 0.074), one-year mortality (3.3% vs 4.0%; p > 0.999), and amputation (3.3% vs 1.3%; p = 0.496). Conclusion In this non-randomized study, one-stage revision arthroplasty demonstrated similar outcomes including reinfection, re-revision, and readmission rates for the treatment of chronic culture-negative PJI after TKA and THA compared to two-stage revision. This suggests culture negativity may not be a contraindication to one-stage revision arthroplasty for chronic culture-negative PJI in selected patients.

scholarly journals One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

2020 ◽  
Vol 7 ◽  
Author(s):  
Simon Marmor ◽  
Younes Kerroumi ◽  
Vanina Meyssonnier ◽  
Luc Lhotellier ◽  
Antoine Mouton ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Effective Strategy ◽  
One Stage ◽  
Exchange Arthroplasty

The treatment of periprosthetic joint infection: safety and efficacy of two stage versus one stage exchange arthroplasty

2020 ◽  
Vol 17 (3) ◽  
pp. 245-252 ◽  
Author(s):  
Joseph R. Palmer ◽  
Tejbir S. Pannu ◽  
Jesus M. Villa ◽  
Jorge Manrique ◽  
Aldo M. Riesgo ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Stage Versus ◽  
Two Stage ◽  
Safety And Efficacy ◽  
One Stage ◽  
Exchange Arthroplasty

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

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.

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

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.

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

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.

Failure After 2-Stage Exchange Arthroplasty for Treatment of Periprosthetic Joint Infection: The Role of Antibiotics in the Cement Spacer

2018 ◽  
Vol 68 (12) ◽  
pp. 2087-2093 ◽  
Author(s):  
Marjan Wouthuyzen-Bakker ◽  
Michael M Kheir ◽  
Ignacio Moya ◽  
Alexander J Rondon ◽  
Matthew Kheir ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Cement Spacer ◽  
Exchange Arthroplasty

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

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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