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.

scholarly journals Two-Stage Revision Arthroplasty for Periprosthetic Hip Infection: Mean Follow-Up of Ten Years

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Szu-Yuan Chen ◽  
Chi-Chien Hu ◽  
Chun-Chieh Chen ◽  
Yu-Han Chang ◽  
Pang-Hsin Hsieh
Keyword(s):  
Hip Arthroplasty ◽  
Cox Regression ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Harris Hip Score ◽  
Two Stage ◽  
Eradication Of Infection ◽  
The Mean

Background. Two-stage revision hip arthroplasty is the gold standard for treatment of patients with chronic periprosthetic joint infection (PJI), but few studies have reported outcomes beyond short-term follow-up.Methods. A total of 155 patients who underwent two-stage revision arthroplasty for chronic PJI in 157 hips were retrospectively enrolled in this study between January 2001 and December 2010. The mean patient age was 57.5 years, the mean prosthetic age was 3.6 years, and the interim interval was 17.8 weeks. These patients were followed up for an average of 9.7 years.Results. At the latest follow-up, 91.7% of the patients were free of infection. The mean Harris hip score improved significantly from 28.3 points before operation to 85.7 points at the latest follow-up. Radiographically, there was aseptic loosening of the stem or acetabular components in 4 patients. In the multivariate survival analysis using a Cox regression model, repeated debridement before final reconstruction, an inadequate interim period, bacteriuria or pyuria, and cirrhosis were found to be the independent risk factors for treatment failure.Conclusion. Our data show that two-stage revision hip arthroplasty provides reliable eradication of infection and durable reconstruction of the joint in patients with PJI caused by a variety of pathogens.

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.

Major Acetabular Defects Treated with the Burch-Schneider Antiprotrusion Cage and Impaction Bone Allograft in a Large Series: A 5- to 7- Year Follow-up Study

2016 ◽  
Vol 26 (6) ◽  
pp. 585-590 ◽  
Author(s):  
Axel Marx ◽  
Alexander Beier ◽  
Anne Richter ◽  
Christoph H. Lohmann ◽  
Andreas M. Halder
Keyword(s):  
Joint Infection ◽  
Revision Arthroplasty ◽  
Bone Allograft ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Consecutive Series ◽  
Hip Revision ◽  
Acetabular Bone ◽  
Acetabular Bone Defects

Introduction Major bone defects are the greatest challenge in hip revision arthroplasty. Methods In a prospective, consecutive nonrandomised study we followed up 74 patients with Type III (AAOS) acetabular bone defects who underwent revision hip arthroplasty with bone grafting and implantation of a Burch-Schneider anti-protrusion cage (APC). The patients were examined pre- and postoperatively according to a standardised clinical and radiological protocol. No patient was lost to follow-up. Results 9 patients died before follow-up. In 9 other patients the APC was revised within the follow-up period. In 4 of these patients the revision was necessary because of aseptic loosening. In the remaining 5 cases joint infection, recurrent dislocation and 1 trauma were the reasons for revision. 56 patients were included in the statistical analysis. In the follow-up group the mean Harris Hip Score increased from 39.9 preoperatively to 73.2. 85% of the patients assessed their operation result as good or excellent. Conclusions In a large consecutive series the Burch-Schneider anti-protrusion cage proved to be a valuable option in the treatment of major acetabular bone defects in hip revision surgery.

Reconstruction of Severe Acetabular Bone Defects in Revision Hip Arthroplasty Management options and clinical outcomes

2018 ◽  
Vol 69 (8) ◽  
pp. 2217-2221
Author(s):  
Stefan Mogos ◽  
George Viscopoleanu ◽  
Monica Dascalu ◽  
Radu Orfanu
Keyword(s):  
Revision Arthroplasty ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Management Options ◽  
Acetabular Bone ◽  
Type Iiia ◽  
Acetabular Bone Defects ◽  
The Mean ◽  
Acetabular Defects

The objective of this study was to evaluate the effectiveness of different surgical implants for the reconstruction of severe acetabular bone defects in revision arthroplasty of the hip. The current study is a retrospective study on 32 patients with Paprosky type IIIA or IIIB acetabular defects operated between January 2012-December 2015 in a single hospital. The mean follow-up was 21 months (12-43 months). Five different types of reconstruction methods were used: primary uncemented cups with or without screws, cemented acetabular cups, tantalum cups, metal augments and antiprotrusio cages. Bone allograft was available in all cases. Functional outcome after surgery was evaluated using Harris Hip Score. Based on Paprosky classification, the study included 16 type IIIA and 16 type IIIB acetabular defects. Bone graft was used in 71.8% of the cases (23 out of 32 patients). Tantalum cups were used in 15 cases (46.9%), being the preferred implant. Primary uncemented cups were used in 2 cases, cemented acetabular cups were used in 4 cases, trabecular metal augments were used in 5 cases and antiprotrusion cages were used in 6 cases. The mean Harris Hip Score improved from 37.3�7.4 pre-operatively to 82.1�7.2 at final follow-up. In conclusion, the current study demonstrates that various methods of reconstruction are efficient in the short and medium-term.

scholarly journals The results of screw augmentation of acetabular cement spacers for the treatment of periprosthetic hip joint infection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jing-Yao Jin ◽  
Taek-Rim Yoon ◽  
Kyung-Soon Park ◽  
Sheng-Yu Jin ◽  
Dong-Min Jung ◽  
...  
Keyword(s):  
Joint Infection ◽  
Revision Arthroplasty ◽  
Harris Hip Score ◽  
Cement Spacer ◽  
Two Stage ◽  
Screw Augmentation ◽  
Medial Migration ◽  
Total Movement ◽  
Group 2 ◽  
Group 1

Abstract Introduction Prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) is widely used in two-stage revision arthroplasty in periprosthetic joint infection (PJI) after total hip arthroplasty (THA). In our institution, we encountered several cases of acetabular cement spacer dislodgement. The aim of this study was to compare the results of two-stage revision arthroplasties with antibiotic-loaded cement spacers with or without screws on the acetabulum for PJI. Patients and methods This retrospective study included 44 patients who underwent a two-stage revision THA for PJI from June 2007 to May 2017. We divided the patients into two groups: group 1 consisted of 21 patients (21 hips) who underwent two-stage revision arthroplasty with screw augmentation, while group 2 consisted of 23 patients (23 hips) who underwent the same surgery without screw augmentation at the acetabular cement spacer. We compared the migration and dislodgement of the acetabular cement spacer between the two groups. Results Before the second-stage surgery, there was less vertical migration of the cement spacer in group 1 compared to group 2 (1.2 mm vs 3.1 mm, p < 0.001). There was also less medial migration of the cement spacer in group 1 (0.6 mm vs 1.6 mm, p = 0.001). After the first stage, the mean Harris Hip score was significantly higher in group 1 than in group 2 (75 vs 65, p = 0.033). Cement spacer rotation or total movement out of the acetabular area occurred in six patients, all in group 2. After first stage reinfection occurred in two patients, one in each group. Conclusions Screw augmentation to the acetabulum in the first-stage surgery provides better stability of acetabular antibiotic cement spacers without increasing reinfection rate.

scholarly journals Two Stage Hip Revision in Periprosthetic Infection: Results of 41 Cases

2010 ◽  
Vol 4 (1) ◽  
pp. 193-200 ◽  
Author(s):  
Giovanni Pignatti ◽  
Shingo Nitta ◽  
Nicola Rani ◽  
Dante Dallari ◽  
Giacomo Sabbioni ◽  
...  
Keyword(s):  
Joint Infection ◽  
Treatment Protocol ◽  
Revision Arthroplasty ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Cement Spacer ◽  
Two Stage ◽  
Hip Prostheses ◽  
Spacer Group ◽  
The One

Background:two-stage revision is considered the best treatment approach for the eradication of chronic joint infection. We report the outcome of 41 consecutive patients with infected hip prostheses, treated between 2000 and 2005, with two-stage revision using an antibiotic-loaded cement spacer.Methods:Patients underwent a treatment protocol which included clinical and radiographic evaluation, laboratory investigations, hip aspiration, 99mTc-MDP and 99mTc-leukocyte-labeled scintigraphy and intraoperative assessment. All patients were diagnosed with a late chronic infection and classified as B-host according to the Cierny-Mader classification system. 9 patients out of 41 (22%) required a second interim treatment period, with exchange of the spacer. The proportion of methicillin-resistant Staphylococcus was similar between the one-spacer group and two-spacer group (28%vs33%), whereas the proportion of patients with three or more risk factors was significantly higher in the two-spacer group than in the one-spacer group (28%vs55%, respectively).Results:Forty patients had final reimplantation, one patient had a resection arthroplasty. At an average follow-up of 5.3 years no recurrence of infection occurred. The average post-operative Harris hip score improved from 41 to 80.Conclusions:In the treatment of two-stage revision arthroplasty the adherence to the protocol proved to be effective for infection eradication and final reimplantation.

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.

Current actual success rate of the two-stage exchange arthroplasty strategy in chronic hip and knee periprosthetic joint infection

2020 ◽  
Vol 102-B (12) ◽  
pp. 1682-1688
Author(s):  
Pablo S. Corona ◽  
Matías Vicente ◽  
Lluís Carrera ◽  
Dolors Rodríguez-Pardo ◽  
Sebastián Corró
Keyword(s):  
Risk Factors ◽  
Success Rate ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Success Rates ◽  
Two Stage ◽  
Medical Issues ◽  
American Society

Aims The success rates of two-stage revision arthroplasty for infection have evolved since their early description. The implementation of internationally accepted outcome criteria led to the readjustment of such rates. However, patients who do not undergo reimplantation are usually set aside from these calculations. The aim of this study was to investigate the outcomes of two-stage revision arthroplasty when considering those who do not undergo reimplantation, and to investigate the characteristics of this subgroup. Methods A retrospective cohort study was conducted. Patients with chronic hip or knee periprosthetic joint infection (PJI) treated with two-stage revision between January 2010 and October 2018, with a minimum follow-up of one year, were included. Variables including demography, morbidity, microbiology, and outcome were collected. The primary endpoint was the eradication of infection. Patients who did not undergo reimplantation were analyzed in order to characterize this subgroup better. Results A total of 162 chronic PJIs were included in the study. After a mean follow-up of 57.3 months (12.1 to 115.7), 18 patients (11.1%) did not undergo reimplantation, due either to medical issues (10), the patient’s choice (4), or death (4). When only considering those who underwent reimplantation, the success rate was 80.6%. However, when those who did not undergo reimplantation were included, the success rate dropped to 71.6%. Advanced age, American Society of Anesthesiologists grade ≥ III, McPherson’s C host, and Gram-negative related PJI were independent risk factors for retention of the spacer. The mortality was higher in the non-reimplanted group. Conclusion The real success rate of two-stage revision may not be as high as previously reported. The exclusion of patients who do not undergo reimplantation resulted in a 9% overestimation of the success rate in this series. Many comorbidity-related risk factors for retention of the spacer were identified, as well as higher death rates in this group. Efforts should be made to optimize these patients medically in order to increase reimplantation and success rates, while decreasing mortality. Cite this article: Bone Joint J 2020;102-B(12):1682–1688.

scholarly journals Modular tapered conical revision stem in hip revision surgery: mid- term results

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Loris Perticarini ◽  
Stefano Marco Paolo Rossi ◽  
Alberto Fioruzzi ◽  
Eugenio Jannelli ◽  
Mario Mosconi ◽  
...  
Keyword(s):  
Preoperative Assessment ◽  
Bone Defects ◽  
Implant Design ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Stem Design ◽  
Additional Surgery ◽  
Prime Concern ◽  
Distal Fixation

Abstract Background The aim of this paper is to evaluate the clinical and radiological outcomes of a fluted tapered modular distal-fixation stem at medium to long-term follow-up. The hypothesis of this investigation was to verify if the use of this implant design may have provided potential advantages in femoral revisions and post-traumatic instances where the restoration of the anatomy was the prime concern. Methods We retrospectively reviewed 62 cases of femoral revision surgeries, performed in Paprosky type IIIA and IIIB bone defects between January 2001 and December 2011 with a mean follow-up of 8.5 ± 1.5 years (range 5.1–15.9 years) where a modular fluted stem was used. The clinical assessment was performed with the Harris Hip Score (HHS), and the radiographic evaluation was carried in order to assess the stability of the femoral component. Intra-operative and postoperative complications were recorded, and the rates of complications and revisions for any cause were determined. Results Mean HHS improved 35.4 points from the preoperative assessment. Radiographic evaluation showed a stable stem anchorage in 90.3% of the cases at the last follow-up. Five (8%) implants required additional surgery. Neither breakage of the stem nor loosening of the taper junction were recorded. Kaplan-Meier survivorship was 89.4% (CI: 88.8–90%) for any complication and 92.3% (CI: 91.8–92.7%) according to revision for any causes at 81 months follow-up. Conclusions Our findings suggest that this stem design is a reliable option in cases of complex femoral bone defects, as well as in cases with high functional deficiencies, with promising survivorship.

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