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Okewunmi J, Yendluri A, Cordero JK, Zubizarreta N, Chen D, Moucha CS, Poeran J, Hayden BL. Patient Factors Associated With Reimplantation After Girdlestone Resection Arthroplasty for Treatment of Periprosthetic Joint Infections of the Hip. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202409000-00007. [PMID: 39269906 PMCID: PMC11404882 DOI: 10.5435/jaaosglobal-d-24-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 07/06/2024] [Indexed: 09/15/2024]
Abstract
INTRODUCTION For patients unsuitable for prosthesis reimplantation or temporary spacer placement, Girdlestone resection arthroplasty (GRA) is a suitable option to eliminate infection. Using a large-scale database, this study aims to determine factors associated with reimplantation. METHODS This study included patients who underwent GRA and subsequent total hip arthroplasty (2012 to 2015 Medicare Limited Data Set with ≥5-year follow-up). A mixed-effects model measured associations between patient characteristics and reimplantation. Odds ratios (OR) with 95% confidence intervals (CI) were reported. RESULTS Among 2,772 GRA cases, 2,025 (73.1%) were reimplanted (median time to reimplantation 3.0 months). In multivariable analysis, patient factors associated with reduced odds of reimplantation were increased age (OR 0.96; CI, 0.94 to 0.97; P < 0.0001), Black race (OR, 0.58; CI, 0.37 to 0.90; P = 0.0149), obesity (OR, 0.74; CI, 0.58 to 0.94; P = 0.0150), and increased Deyo-Charlson comorbidities (1 comorbidity: OR, 0.78; CI, 0.61 to 0.99; P = 0.0453; two comorbidities: OR, 0.53; CI, 0.39 to 0.71; P < 0.0001; ≥3 comorbidities: OR, 0.69; CI, 0.49 to 0.95; P = 0.0244). Male (versus female) patients, however, had increased odds of reimplantation (OR, 1.64; CI, 1.32 to 2.02; P < 0.0001). DISCUSSION Age, race, and comorbidities influence the likelihood of reimplantation after GRA. Owing to variability in patients who undergo additional surgery, additional studies should be conducted to determine the rationale of patient selection.
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Affiliation(s)
- Jeffrey Okewunmi
- From the Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
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Kayani B, Bengoa F, Howard LC, Neufeld ME, Masri BA. Articulating Spacers in Total Hip Arthroplasty: Surgical Technique and Outcomes. Orthop Clin North Am 2024; 55:181-192. [PMID: 38403365 DOI: 10.1016/j.ocl.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Although one-stage exchange arthroplasty is gaining popularity, two-stage exchange arthroplasty remains the gold standard for the treatment of periprosthetic joint infections. Use of an articulating spacer for this procedure offers an avenue for maintaining hip motion and controlled weight-bearing, allowing local antibiotic elution. However, there is no uniform consensus on the optimal surgical protocol for using articulating spacers. This review describes the surgical technique for undertaking a first-stage exchange arthroplasty using an articulating spacer and discusses the pertinent literature on key concepts relating to periprosthetic joint infections in total hip arthroplasty to guide effective surgical decision making in these patients.
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Affiliation(s)
- Babar Kayani
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada.
| | - Francisco Bengoa
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Lisa C Howard
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Michael E Neufeld
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Bassam A Masri
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
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Russo A, Migliorini F, Giustra F, Bosco F, Massè A, Burastero G. Two-stage total joint replacement for hip or knee septic arthritis: post-traumatic etiology and difficult-to-treat infections predict poor outcomes. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05249-x. [PMID: 38430234 DOI: 10.1007/s00402-024-05249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Septic arthritis (SA) is a rare but significant clinical challenge in orthopedics that can impact patients' quality of life. This study aims to examine the clinical outcomes of patients undergoing two-stage total joint replacement (TJR) in hip and knee SA and analyze potential predictors of treatment failure. METHODS A retrospective analysis was conducted using data from a prospectively collected institutional arthroplasty registry from January 1st, 2012, to January 1st, 2019. Patients with hip or knee SA who underwent a two-stage TJR and had at least two years of follow-up were included. Demographic characteristics, surgical variables, and outcomes were collected and analyzed from clinical and surgical data. Statistical analysis was performed using IBM SPSS Statistics, with statistical significance at p < 0.05. RESULTS One hundred and fourteen patients (61 with hip SA, 53 with knee SA) were included in the study. The mean follow-up was 72.8 months. Postoperatively, both clinical and functional outcomes significantly improved, as indicated by the Hip Society Score (HHS) and Knee Society Score (KSS). The overall success rate of the two-stage protocol was 89.5%. Complications that did not require revision occurred in 21% of cases. The most identified pathogen was methicillin-sensitive Staphylococcus aureus (MSSA). Difficult-to-treat (DTT) infections and post-traumatic etiology were identified as predictors of treatment failure in patients undergoing two-stage TJR for hip and knee SA. CONCLUSIONS Two-stage TJR in hip and knee SA demonstrated favorable clinical outcomes at mid-term follow-up. The procedure significantly improved functional scores and achieved a high success rate, while DTT infections and post-traumatic etiology were associated with a higher risk of treatment failure.
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Affiliation(s)
- Antonio Russo
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29 10126, Turin, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Bolzano, 39100, Italy
| | - Fortunato Giustra
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | - Francesco Bosco
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy.
- Department of Orthopaedics and Traumatology, G.F. Ingrassia Hospital Unit, ASP 6, Palermo, Italy.
| | - Alessandro Massè
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29 10126, Turin, Italy
| | - Giorgio Burastero
- IRCCS Ospedale Galeazzi-Sant'Ambrogio, Via Cristina Belgioioso 173, Milan, 20157, Italy
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Gramlich Y, Parvizi J. Enough is enough: salvage procedures in severe periprosthetic joint infection. ARTHROPLASTY 2023; 5:36. [PMID: 37394449 PMCID: PMC10316561 DOI: 10.1186/s42836-023-00182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/31/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND In severe cases of periprosthetic joint infection involving negative host-dependent factors, individual-based decisions between a curative therapy vs. salvage procedure are necessary. We aimed to review salvage procedures in severe periprosthetic joint infection cases, where a gold standard of a curative two-stage exchange can no longer be achieved. The options of knee arthrodesis, amputation, persistent fistula (stable drainage), or a debridement, antibiotics, and implant retention procedure in late-onset cases are discussed, including lifelong antibiotic suppression alone. METHODS We focused on known salvage procedures for severe periprosthetic joint infection of the hip and knee, such as amputation, arthrodesis, antibiotic suppression, persistent fistula, and debridement, antibiotics, and implant retention in late-stage infections, and the role of local antibiotics. The current literature regarding indications and outcomes was reviewed. RESULTS Whereas a successful single-stage above-knee amputation can be a curative effort in younger patients, this is associated with limited outcome in older patients, as the proportion who receive an exoprosthesis leading to independent mobility is low. Therefore, arthrodesis using an intramedullary modular nail is an option for limb salvage, pain reduction, and preservation of quality of life and everyday life mobility, when revision total knee arthroplasty is not an option. Carrying out a persistent fistula using a stable drainage system, as well as a lifelong antibiotic suppression therapy, can be an option, in cases where no other surgery is possible. Active clinical surveillance should then be carried out. A debridement, antibiotics, and implant retention procedure in combination with local degradable antibiotics can be used and is an encouraging new option, but should not been carried out twice. CONCLUSION Whereas the gold standard in periprosthetic joint infection treatment of late infections remains the exchange of the prosthesis, salvage procedures should be considered in the cases of reduced life expectancy, several recurrences of the infection, patients having preference and negative host factors. In these cases, the appropriate salvage procedure can temporarily lead to remission of the infection and the possibility to maintain mobility.
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Affiliation(s)
- Yves Gramlich
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, Frankfurt, 60389, Germany.
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, 19107, USA
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Fiore M, Rondinella C, Paolucci A, Morante L, De Paolis M, Sambri A. Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections. Hip Pelvis 2023; 35:32-39. [PMID: 36937214 PMCID: PMC10020733 DOI: 10.5371/hp.2023.35.1.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 03/21/2023] Open
Abstract
Purpose A staged revision with placement of a temporary antibiotic-loaded cement spacer after removal of the implant is the "gold standard" for treatment of chronic prosthetic joint infection (PJI). It enables local delivery of antibiotics, maintenance of limb-length and mobility, easier reimplantation. However, bacterial colonization of spacers and mechanical complications can also occur. The aim of this study is to evaluate functional results and infection control in two-stage treatment of total hip arthroplasty (THA) PJI with and without a spacer. Materials and Methods A retrospective review of 64 consecutive patients was conducted: 34 underwent two-stage revision using a cement spacer (group A), 30 underwent two-stage revision without a spacer (group B). At the final follow-up, functional evaluation of patients with a THA in site, without PJI recurrence, was performed using the Harris hip score (HHS). Measurement of limb-length and off-set discrepancies was performed using anteroposterior pelvic X-rays. Results Most patients in group B were older with more comorbidities preoperatively. Thirty-three patients (97.1%) in group A underwent THA reimplantation versus 22 patients (73.3%) in group B (P<0.001). No significant differences in limb-length and off-set were observed. The results of functional evaluation performed during the final follow-up (mean, 41 months) showed better function in patients in group A (mean HHS, 76.3 vs. 55.9; P<0.001). Conclusion The use of antibiotic-loaded cement spacer seems superior in terms of functional outcomes and reimplantation rate. Resection arthroplasty might be reserved as a first-stage procedure in patients who are unfit, who might benefit from a definitive procedure.
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Affiliation(s)
- Michele Fiore
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Claudia Rondinella
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Azzurra Paolucci
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Morante
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Massimiliano De Paolis
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Andrea Sambri
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
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Hipfl C, Karczewski D, Oronowicz J, Pumberger M, Perka C, Hardt S. Total hip arthroplasty for destructive septic arthritis of the hip using a two-stage protocol without spacer placement. Arch Orthop Trauma Surg 2023; 143:19-28. [PMID: 34097122 PMCID: PMC9886611 DOI: 10.1007/s00402-021-03981-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The optimal treatment of patients with a degenerative joint disease secondary to an active or chronic septic arthritis of the hip is unclear. The aim of the present study was to report on our experience with two-stage total hip arthroplasty (THA) using a contemporary treatment protocol without spacer insertion. MATERIALS AND METHODS Our prospective institutional database was used to identify all patients with degenerative septic arthritis treated with a non-spacer two-stage protocol between 2011 and 2017. Clinical outcomes included interim revision, periprosthetic infection (PJI) and aseptic revision rates. Restoration of leg-length and offset were assessed radiographically. Modified Harris hip score (mHHS) were obtained. Treatment success was defined using the modified Delphi consensus criteria. Mean follow-up was 62 months (13-110). RESULTS A total of 33 patients with a mean age of 60 years (13-85) were included. 55% of the cohort was male and average Charlson Comorbidity Index (CCI) was 3.7 (0-12). 21 patients (64%) had an active/acute infection and 12 patients (36%) were treated for chronic/quiescent septic arthritis. Overall, 11 patients (33%) had treatment failure, including 5 patients who failed to undergo THA, 2 interim re-debridement for persistent infection, and 4 patients who developed PJI after an average of 7 months (0.3-13) following THA. The most common identified pathogen was Staphylococcus aureus (42.4%). No aseptic revision was recorded following THA. Leg-length and offset were successfully restored. Mean mHHS improved from 35.2 points to 73.4 points. CONCLUSION Two-stage THA without spacer placement is a viable treatment option for destructive septic arthritis of the hip, demonstrating comparable rates of infection control and functional outcome. However, definitive resection arthroplasty is not uncommon in these often critically ill patients.
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Affiliation(s)
- Christian Hipfl
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Daniel Karczewski
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jakub Oronowicz
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Pumberger
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Carsten Perka
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sebastian Hardt
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Nazemi AK, Upfill-Brown A, Arshi A, Sekimura T, Zeegen EN, McPherson EJ, Stavrakis AI. Analysis of perioperative outcomes in hip resection arthroplasty. Arch Orthop Trauma Surg 2022; 142:2139-2146. [PMID: 33625542 DOI: 10.1007/s00402-021-03833-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hip resection arthroplasty (HRA) is a salvage surgical technique for the management of complex hip conditions wherein arthroplasty may be contraindicated. The purpose of this study was to review modern-day indications for HRA and compare outcomes between patients undergoing HRA and revision total hip arthroplasty (RTHA). METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was used to identify patients undergoing HRA or RTHA between 2012 and 2017. Patient demographics, risk factors, and perioperative complications were analyzed. Multivariate regression was used to determine predictors of early postoperative complications. Propensity score matching (PSM) was performed to compare relative risks (RR) of complications in HRA compared to RTHA. RESULTS 290 patients underwent HRA between 2012 and 2017. Infection was the most common indication for HRA (39.8%), followed by femoral neck fracture or malunion/nonunion (26%) and prosthetic instability (12.2%). Increased body mass index (BMI) (p = 0.012) and chronic obstructive pulmonary disease (COPD) (p = 0.007) were associated with increased risk of complication in HRA. There were no significant differences in short-term complication risks between RTHA and HRA. CONCLUSIONS HRA was associated with short-term complication rates comparable to RTHA. These findings may help in surgical decision-making and appropriate indications in the present day. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alireza K Nazemi
- Department of Orthopaedic Surgery, Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, HSC T18-089, Stony Brook, NY, 11794, USA.
| | - Alexander Upfill-Brown
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 755, Los Angeles, CA, 90095, USA
| | - Armin Arshi
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 755, Los Angeles, CA, 90095, USA
| | - Troy Sekimura
- David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Erik N Zeegen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 755, Los Angeles, CA, 90095, USA
| | - Edward J McPherson
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 755, Los Angeles, CA, 90095, USA
| | - Alexandra I Stavrakis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 755, Los Angeles, CA, 90095, USA
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Zhang CF, Fang XY, Huang ZD, Bai GC, Zhang ZY, Yang Y, Zhang ZJ, Li WB, Zhang WM. Surgical Management for Chronic Destructive Septic Hip Arthritis: Debridement, Antibiotics, and Single-Stage Replacement is as Effective as Two-Stage Arthroplasty. Orthop Surg 2022; 14:1175-1185. [PMID: 35583090 PMCID: PMC9163978 DOI: 10.1111/os.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To compare the surgical outcomes of debridement, antibiotics, and single‐stage total hip replacement (DASR) vs two‐stage arthroplasty (two‐stage arthroplasty) for chronic destructive septic hip arthritis (SHA). Methods Cases of chronic destructive SHA treated by DASR or two‐stage arthroplasty in our department from January 2008 to October 2021 were retrospectively reviewed. Patient demographic information, perioperative inflammation markers, intraoperative blood loss, microbial culture, and metagenomic new generation sequencing results were recorded. The perioperative complications, hospital stay, hospitalization cost, infection recurrence rate, and Harris Hip Score (HHS) at the last follow‐up were compared between the two groups. Results A total of 28 patients were included in the study, including 11 patients who received DASR and 17 patients who received two‐stage arthroplasty. There was no significant difference in demographic information, preoperative serum inflammatory markers, synovial fluid white blood cell count, or percentage of polymorphonuclear leukocytes between the two groups. The DASR group demonstrated significantly lower intraoperative blood loss [(368.2 ± 253.3) mL vs (638.2 ± 170.0) mL, p = 0.002], hospital stay [(22.6 ± 8.1) days vs (43.5 ± 13.2) days, p < 0.0001], and hospitalization expenses [(81,269 ± 11,496) RMB vs (137,524 ± 25,516) RMB, p < 0.0001] than the two‐stage arthroplasty group. In the DASR group, one patient had dislocation as a complication. There were no cases with recurrence of infection. In the two‐stage arthroplasty group, there was one case complicated with spacer fracture, one case with spacer dislocation, and one case with deep vein thrombosis of the lower limbs. There were no cases with recurrence of infection. There were no significant differences in the readmission rate, complication rate, or HHS at the last follow‐up between the two groups. Conclusions Both DASR and two‐stage arthroplasty achieved a satisfactory infection cure rate and functional recovery for chronic destructive SHA, and DASR demonstrated significantly lower intraoperative blood loss, hospital stay, and hospitalization costs than two‐stage arthroplasty. For appropriately indicated patients, if microbial data are available and a standardized debridement protocol is strictly followed, DASR can be a treatment option.
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Affiliation(s)
- Chao-Fan Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xin-Yu Fang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zi-da Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guo-Chang Bai
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ze-Yu Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ye Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zi-Jie Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen-Bo Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen-Ming Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Piscopo A, Pola E, Fusini F, Cipolloni V, Piscopo D, Colò G, Zanchini F. Revision arthroplasty with megaprosthesis after Girdlestone procedure for periprosthetic joint infection as an option in massive acetabular and femoral bone defects. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 92:e2021531. [PMID: 35604274 PMCID: PMC9437688 DOI: 10.23750/abm.v92is3.12160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022]
Abstract
Background and aim: To evaluate the clinical outcomes of patients treated with Girdlestone procedure (GP) or excision arthroplasty (EA) for periprosthetic infection with massive bone defects and undergoing revision arthroplasty. Methods: All patients treated with EA or GP for hip periprosthetic infection between 2014 and 2017 and sustaining revision arthroplasty (RA) were included in the study. Patients with less than 24 months of follow-up or less than 12 months between GP or EA and RA were excluded. Any sign of implant mobilization or periprosthetic fracture was assessed through X-ray. Patients were evaluated with D’aubigne-Postel hip score before RA and at the last follow-up. Mann-Whitney U test was used to assess differences between pre-RA surgery and last follow-up. P value was set as <0.05. Results: Twelve patients meet the inclusion criteria (mean follow-up 58+/-9.72 months). No radiographic sign of implant mobilization or periprosthetic fracture was reported. A significant difference was found for each parameter of the D’Aubigne-Postel score (p < 0.0001); none of the patients reached more than fair results in the absolute hip score. The difference between pre and post-operative global status showed a fair improvement. A significant difference was found for leg length discrepancy between pre and post RA (p<0.0001). Conclusions: Conversion from EA or GP to RA in patients suffering from massive acetabular and femur defects is challenging; conversion procedure is able to reduce patients’ disability and to improve walking ability. (www.actabiomedica.it)
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Affiliation(s)
| | - Enrico Pola
- Clinical Orthopaedics, University of Campania "Luigi Vanvitelli", via L. de Crecchio 4, Naples, Italy.
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, University of Turin, via Zuretti 29, 10121, Turin.
| | - Valerio Cipolloni
- Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Catholic University of Rome, Italy.
| | - Davide Piscopo
- Clinical Orthopaedics, University of Campania "Luigi Vanvitelli", via L. de Crecchio 4, Naples, Italy.
| | - Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, AA Antonio e Biagio e Cesare Arrigo, Alessandria, Italy..
| | - Fabio Zanchini
- Clinical Orthopaedics, University of Campania "Luigi Vanvitelli", via L. de Crecchio 4, Naples, Italy.
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Extended Trochanteric Osteotomy with Intermediate Resection Arthroplasty Is Safe for Use in Two-Stage Revision Total Hip Arthroplasty for Infection. J Clin Med 2021; 11:jcm11010036. [PMID: 35011776 PMCID: PMC8745126 DOI: 10.3390/jcm11010036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 12/03/2022] Open
Abstract
Background: This study sought to compare the results of two-stage revision total hip arthroplasty (THA) for periprosthetic infection (PJI) in patients with and without the use of an extended trochanteric osteotomy (ETO) for removal of a well-fixed femoral stem or cement. Methods: Thirty-two patients who had undergone an ETO as part of a two-stage revision without spacer placement were matched 1:2 with a cohort of sixty-four patients of the same sex and age who had stem removal without any osteotomy. Clinical outcomes including interim revision, reinfection and aseptic failure rates were evaluated. Modified Harris hip scores (mHHS) were calculated. Minimum follow-up was two years. Results: Patients undergoing ETO had a significantly lower rate of interim re-debridement compared to non-ETO patients (0% vs. 14.1%, p = 0.026). Reinfection following reimplantation was similar in both groups (12.5% in ETO patients vs. 9.4% in non-ETO patients, p = 0.365). Revision for aseptic reason was necessary in 12.5% in the ETO group and 14.1% in the non-ETO group (p = 0.833). Periprosthetic femoral fractures were seen in three patients (3.1%), of which all occurred in non-ETO patients. Dislocation was the most common complication, which was equally distributed in both groups (12.5%). The mean mHHS was 37.7 in the ETO group and 37.3 in the non-ETO group, and these scores improved significantly in both groups following reimplantation (p < 0.01). Conclusion: ETO without the use of spacer is a safe and effective method to manage patients with well-fixed femoral stems and for thorough cement removal in two-stage revision THA for PJI. While it might reduce the rate of repeated debridement in the interim period, the use of ETO appears to lead to similar reinfection rates following reimplantation.
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Two-stage arthroplasty for septic arthritis of the hip and knee: A systematic review on infection control and clinical functional outcomes. J Clin Orthop Trauma 2021; 24:101720. [PMID: 34926151 PMCID: PMC8649791 DOI: 10.1016/j.jcot.2021.101720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Septic arthritis of the native hip and knee joint poses particular challenges to orthopedic surgeons. Patients often suffer from several comorbidities, and it could be challenging to find a balance between infection control and adequate function. Two-stage arthroplasty has been addressed as a reliable solution, however the literature on the topic is composed of case series with small sample size. This systematic review aimed to analyze data on infection control and clinical functional outcomes of patients who underwent two-stage arthroplasty for septic arthritis of the hip and knee. METHODS An electronic search of studies published from January 1st, 2000, to June 1st, 2021, was conducted using eight different databases. Following the Cochrane Handbook of Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Revies and Meta-analysis two authors reviewed the available literature and reference lists to identify papers eligible for inclusion. RESULTS A total of 21 studies were included, involving 435 procedures. The mean age was 57.3 ± 6.2 (45.8-71.8) years. The mean follow-up was 53.7 ± 18.6 (12-86.7) months. The mean infection eradication was 93.3 ± 6.4%. Mean Harris Hip Score improved from 32.1 ± 10.6 (11.5-42.9) to 87.5 ± 5.7 (80.6-97.8). Mean Knee Society Score improved from 42.9 ± 7.6 (35.9-58.0) to 86.1 ± 5.4 (80.1-96.0). CONCLUSIONS Two-stage arthroplasty for hip and knee septic arthritis provided high infection control rate and excellent function. Further high-quality studies should be oriented on providing a validated algorithm for diagnosis and treatment of this condition. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Khanna A, Carter B, Gill I. Two-Stage Revision Hip Arthroplasty with or without the Use of an Interim Spacer for Managing Late Prosthetic Infection: A Systematic Review of the Literature. Orthop Surg 2021; 13:384-394. [PMID: 33554443 PMCID: PMC7957390 DOI: 10.1111/os.12875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/19/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022] Open
Abstract
The aim of the present paper was to identify, appraise, and synthesize the available evidence on two-stage revision hip arthroplasty with or without the use of an interim spacer for managing late prosthetic infection. The review methodology was designed by referencing the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist and flow diagram, and a Population, Intervention, Comparator, Outcomes and Study (PICOS) design framework was used to search for studies to incorporate within the review. Two independent investigators were involved in searching for relevant articles that fulfilled the inclusion criteria for the study. Critical appraisal of the selected articles was carried out using the relevant Critical Appraisal Skills Programme checklists. From an initial pool of 125 articles, four studies satisfied the inclusion criteria and quality assessment and were included for final review. Two patient groups were identified from within the selected studies: spacer and non-spacer. Both groups were assessed in terms of functional outcome, infection cure rates, and technical difficulties encountered during treatment. Better functional outcome was reported in the spacer group, both in the interim period between the two stages and after completion of treatment. The use of spacers reduced operative difficulty during the second stage and accelerated patient discharge. Reinfection and infection persistence rates were higher in the non-spacer group. Within the spacer group, articulated spacers performed better in all parameters. The results of this review reinforce the available evidence supporting the use of interim hip spacers in revision hip arthroplasty for managing prosthetic infection and also indicate that articulated hip spacers could be an attractive option going forward.
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Affiliation(s)
- Angshuman Khanna
- Department of Trauma and OrthopaedicsSalford Royal NHS Foundation TrustSalfordUK
| | - Bernie Carter
- Faculty of HealthSocial Care and Medicine, Edge Hill UniversityOrmskirkUK
| | - Inder Gill
- Department of Trauma and OrthopaedicsSalford Royal NHS Foundation TrustSalfordUK
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Russo A, Cavagnaro L, Chiarlone F, Clemente A, Romagnoli S, Burastero G. Clinical outcomes and survivorship of two-stage total hip or knee arthroplasty in septic arthritis: a retrospective analysis with a minimum five-year follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 45:1683-1691. [PMID: 33774699 PMCID: PMC8266791 DOI: 10.1007/s00264-021-05013-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
Purpose Septic arthritis of the native joint is challenging for orthopedic surgeons because it may lead to wide bone defects and severe impairment of joint function. This study aimed to analyze clinical functional outcomes, the rate of infection eradication, and survival of implants of patients who underwent two-stage arthroplasty for septic arthritis of the hip and knee. Methods A retrospective single-centre analysis was conducted of patients treated for septic arthritis of the hip and knee joints through a two-stage surgery between 2012 and 2015. Clinical and radiological records were gathered from the prospectively collected Institutional Arthroplasty Registry. Patients’ pre-operative Harris hip scores and Knee Society scores were compared with those obtained at the latest follow-up. Kaplan–Meier curves were generated to assess survival of implants. Results Forty-seven patients were included. The mean follow-up was 85.2 ± 15.4 months. The Harris hip score improved from 39.4 ± 9.9 to 84.5 ± 10.8 points (p < 0.001). The Knee Society score improved from 40.7 ± 8.4 to 86.0 ± 7.8 points (p < 0.001). Knee Society score-function increased from 25.7 ± 14.2 to 85.4 ± 23.4 points (p < 0.001). The infection eradication rates were 92.0% and 90.9% in patients who underwent hip and knee operation, respectively (p = 0.891). Overall survivorship of implants after the second stage was 93.6%. Conclusions Two-stage arthroplasty provides good to excellent clinical outcomes in cases of active septic arthritis of the hip and the knee, high rates of infection control, and implant survival.
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Affiliation(s)
- Antonio Russo
- Orthopaedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy.
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy.
| | - Luca Cavagnaro
- Joint Arthroplasty Unit, Orthopaedic and Traumatology 2, Santa Corona Hospital, Viale 25 Aprile 38, 17027, Pietra Ligure, Italy
| | - Francesco Chiarlone
- Joint Arthroplasty Unit, Orthopaedic and Traumatology 2, Santa Corona Hospital, Viale 25 Aprile 38, 17027, Pietra Ligure, Italy
| | - Antonio Clemente
- Department of Orthopedics and Traumatology, CTO Hospital, University of Turin, Via G. Zuretti 29, 10126, Turin, Italy
| | - Sergio Romagnoli
- Prosthetic Surgery Centre, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Giorgio Burastero
- Prosthetic Surgery Centre, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
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Restoration of the hip geometry after two-stage exchange with intermediate resection arthroplasty for periprosthetic joint infection. Sci Rep 2021; 11:5221. [PMID: 33664369 PMCID: PMC7933341 DOI: 10.1038/s41598-021-84692-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
Two-stage exchange with intermediate resection arthroplasty (RA) is a well-established surgical procedure in the treatment of chronic periprosthetic joint infection (PJI), whereby a higher failure rate of final hip geometry restoration due to tissue contraction is controversially discussed. The aim was to evaluate radiographic changes of hip geometry parameters during PJI treatment and to determine the impact of the intermediate RA on the final joint restoration after reimplantation of a total hip arthroplasty (reTHA). Radiographic parameters (leg length (LL), femoral offset (FO), horizontal/vertical acetabular center of rotation distance (h/vCORD)) of 47 patients (mean age: 64.1 years) were measured on standard radiographs of the pelvis and compared between four different stages during PJI treatment (pre-replacement status (preTHA), primary total hip arthroplasty (pTHA), RA and reTHA). The RA duration (mean: 10.9 months) and the number of reoperations during this period (mean: n = 2.0) as well as their impact on hip geometry restoration were evaluated. Between preTHA and pTHA/reTHA an equivalent restoration was measured regarding the FO (p < 0.001/p < 0.001) and hCORD (p = 0.016/p < 0.001), but not regarding the LL and vCORD. In contrast, analysis revealed no influence of RA and an equivalent reconstruction of LL (p = 0.003), FO (p < 0.001), v/hCORD (p = 0.039/p = 0.035) at reTHA compared to pTHA. Furthermore, RA duration (p = 0.053) and the number of reoperations after RA (p = 0.134) had no impact on radiographic hip geometry restoration. The two-stage exchange with intermediate RA does not alter the preexisting hip joint parameters, whereby a good restoration of the final hip geometry, independent of the duration or the number of reoperations, can be achieved.
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Kildow BJ, Della-Valle CJ, Springer BD. Single vs 2-Stage Revision for the Treatment of Periprosthetic Joint Infection. J Arthroplasty 2020; 35:S24-S30. [PMID: 32046827 DOI: 10.1016/j.arth.2019.10.051] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/27/2019] [Accepted: 10/27/2019] [Indexed: 02/01/2023] Open
Abstract
Periprosthetic joint infection (PJI) is one of the most devastating complications following total joint arthroplasty, accounting for a projected 10,000 revision surgeries per year by 2030. Chronic PJI is complicated by the presence of bacterial biofilm, requiring removal of components, thorough debridement, and administration of antibiotics for effective eradication. Chronic PJI is currently managed with single-stage or 2-stage revision surgery. To date, there are no randomized, prospective studies available evaluating eradication rates and functional outcomes between the 2 techniques. In this review, both treatment options are described with the most current literature to guide effective surgical decision-making that is cost-effective while decreasing patient morbidity.
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Affiliation(s)
- Beau J Kildow
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina
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Troendlin F, Frieler S, Hanusrichter Y, Yilmaz E, Schildhauer TA, Baecker H. Persistent Fistula for Treatment of a Failed Periprosthetic Joint Infection: Relic From the Past or a Viable Salvage Procedure? J Arthroplasty 2020; 35:544-549. [PMID: 31611161 DOI: 10.1016/j.arth.2019.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/14/2019] [Accepted: 09/07/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND New treatment algorithms for periprosthetic joint infections (PJIs) show high success rates in achieving permanent infection eradication with some degree of failure. Different salvage procedures are described, but there is no evidence for persistent fistula (PF). The purpose of this study was to analyze PF as a salvage procedure in patients with therapy-resistant PJIs. METHODS This retrospective analysis included all patients treated with PF (2005-2018) in a maximum care center with PJI (knee or hip). The baseline parameters (age, sex, BMI) and other data (number of surgeries, pathogen spectrum, American Society of Anesthesiologists classification) were recorded. The function was documented using the Harris Hip Score, the Knee Society Score, and the quality of life using the SF-36 Health Survey. RESULTS A total of 159 patients were included (80 ± 12 years) and subdivided into four groups: hip (n = 66), knee (n = 13), Girdlestone resection arthroplasty (n = 50), knee arthrodesis (n = 27). Patients stayed 111 ± 87 days in the hospital, underwent six operations and three revisions after establishing PF. The mean American Society of Anesthesiologists score was 2.7. The BMI was 31 ± 3 kg/m2 (P = .1). The follow-up was 2.8 ± 0.5 years including 27 patients. The Harris Hip Score and Knee Society Score were 38 and 34, respectively. SF-36 showed no significant difference. CONCLUSION The study showed poor outcomes regarding quality of life and the function of the infected joint. Therefore, the indication for establishing a PF in the treatment of PJI must be assessed very critically. PF is only an option for multimorbid patients with a limited life expectancy.
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Affiliation(s)
- Florian Troendlin
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Sven Frieler
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Yannik Hanusrichter
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Emre Yilmaz
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Hinnerk Baecker
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
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Sigmund IK, Winkler T, Önder N, Perka C, Renz N, Trampuz A. Complications of Resection Arthroplasty in Two-Stage Revision for the Treatment of Periprosthetic Hip Joint Infection. J Clin Med 2019; 8:E2224. [PMID: 31888226 PMCID: PMC6947094 DOI: 10.3390/jcm8122224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/08/2019] [Accepted: 12/13/2019] [Indexed: 12/12/2022] Open
Abstract
Little data is available regarding complications associated with resection arthroplasty in the treatment of hip periprosthetic joint infection (PJI). We assessed complications during and after two-stage revision using resection arthroplasty. In this retrospective study, 93 patients undergoing resection arthroplasty for hip PJI were included. Patients were assigned to a prosthesis-free interval of ≤10 weeks (group 1; 49 patients) or >10 weeks (group 2; 44 patients). The complication rates between groups were compared using the chi-squared test. The revision-free and infection-free survival was estimated using a Kaplan-Meier survival analysis. Seventy-one patients (76%) experienced at least one local complication (overall 146 complications). Common complications were blood loss during reimplantation (n = 25) or during explantation (n = 23), persistent infection (n = 16), leg length discrepancy (n = 13) and reinfection (n = 9). Patients in group 1 experienced less complications after reimplantation (p = 0.012). With increasing severity of acetabular bone defects, higher incidence of complications (p = 0.008), periprosthetic bone fractures (p = 0.05) and blood loss (p = 0.039) was observed. The infection-free survival rate at 24 months was 93.9% in group 1 and 85.9% in group 2. The indication for resection arthroplasty needs to be evaluated carefully, considering the high rate of complications and reduced mobility, particularly if longer prosthesis-free intervals are used.
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Affiliation(s)
- Irene K. Sigmund
- Center for Musculoskeletal Surgery (CMSC), Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, D-10117 Berlin, Germany; (T.W.); (C.P.); (N.R.); (A.T.)
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Spitalgasse 23, A-1090 Vienna, Austria
| | - Tobias Winkler
- Center for Musculoskeletal Surgery (CMSC), Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, D-10117 Berlin, Germany; (T.W.); (C.P.); (N.R.); (A.T.)
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charite-Universitatsmedizin Berlin, Fohrer Str. 15, 13353 Berlin, Germany
| | - Nuri Önder
- Center for Musculoskeletal Surgery (CMSC), Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, D-10117 Berlin, Germany; (T.W.); (C.P.); (N.R.); (A.T.)
| | - Carsten Perka
- Center for Musculoskeletal Surgery (CMSC), Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, D-10117 Berlin, Germany; (T.W.); (C.P.); (N.R.); (A.T.)
| | - Nora Renz
- Center for Musculoskeletal Surgery (CMSC), Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, D-10117 Berlin, Germany; (T.W.); (C.P.); (N.R.); (A.T.)
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery (CMSC), Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, D-10117 Berlin, Germany; (T.W.); (C.P.); (N.R.); (A.T.)
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charite-Universitatsmedizin Berlin, Fohrer Str. 15, 13353 Berlin, Germany
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Yang FS, Lu YD, Wu CT, Blevins K, Lee MS, Kuo FC. Mechanical failure of articulating polymethylmethacrylate (PMMA) spacers in two-stage revision hip arthroplasty: the risk factors and the impact on interim function. BMC Musculoskelet Disord 2019; 20:372. [PMID: 31412841 PMCID: PMC6694660 DOI: 10.1186/s12891-019-2759-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 08/09/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study aimed to investigate the risk factors for mechanical failure of cement spacers and the impact on hip function after two-stage exchange arthroplasty for periprosthetic joint infection (PJI). METHODS Thirty-one patients (19 males and 12 females) with hip PJIs underwent resection arthroplasty and implantation of cement spacers from January 2014 to December 2015. Patients who encountered spacer-associated mechanical complications in the interim period (14 of 31) were compared with those without complications (17 of 31). Complications were defined as spacer dislocation, spacer fracture, spacer fracture with dislocation, and femoral fracture during or following spacer implantation. Hip functional outcome was assessed using the Harris hip score (HHS). Treatment success was defined according to the following criteria: (1) no symptoms or signs indicative of infection; (2) no PJI-related mortality; and (3) no subsequent surgical intervention for infection after reimplantation surgery. Multivariate logistic regression and Kaplan-Meier survival curves were used for analysis. RESULTS Fourteen patients (14/31 = 45%) suffered at least one spacer-related complication within the interim period. The development of spacer complications was associated with a younger age (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.83-1.00, p = 0.045) and chronic PJI (OR 14.7, 95% CI 1.19-182, p = 0.036). Patients with spacer complications also had a lower median HHS (37 vs. 60, p < 0.001) before reimplantation in comparison to those without spacer complications. After reimplantation, the two groups had a similar median HHS (90 vs. 89, p = 0.945). Two patients did not undergo reimplantation due to extensive comorbidities, and subsequently retained the antibiotic spacer for definitive treatment. The 2-year treatment success rate was 84.6% in the spacer-complication group and 87.5% in the non-spacer-complication group (p = 0.81). CONCLUSION There was a high complication rate for articulating PMMA spacers during the interim period of two-stage revision total hip arthroplasty. A young age and chronic infection were the primary risk factors associated with mechanical complications. Patients at high risk of spacer-related mechanical complications should be advised accordingly by surgeons. Knowing the possible risk factors, surgeons should educate patients thoroughly to avoid spacer complications, thereby increasing patient satisfaction in the interim stage. LEVEL OF EVIDENCE Prognostic Level III.
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Affiliation(s)
- Fu-Shine Yang
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, 833 Taiwan
| | - Yu-Der Lu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, 833 Taiwan
| | - Cheng-Ta Wu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, 833 Taiwan
| | - Kier Blevins
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710 USA
| | - Mel S. Lee
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, 833 Taiwan
| | - Feng-Chih Kuo
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, 833 Taiwan
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Kao FC, Hsu YC, Liu PH, Tu YK, Jou IM. High 2-year mortality and recurrent infection rates after surgical treatment for primary septic arthritis of the hip in adult patients: An observational study. Medicine (Baltimore) 2019; 98:e16765. [PMID: 31393395 PMCID: PMC6708796 DOI: 10.1097/md.0000000000016765] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Primary septic arthritis of the hip is rare and potentially devastating in adults. Its optimal surgical treatment and clinical outcomes remain unclear.In this retrospective cohort study, we investigated mortality and reinfection rates after surgery of patients with septic hip arthritis. We reviewed patients treated for primary septic hip joints from October 2005 to December 2016. A total of 51 adult patients were identified, and 38 among them had destructive hip joints. A poor postoperative outcome was defined as mortality or recurrent infection within 2 years of surgery.After surgery, 7 (13.7%) patients died within 1 year and 5 (9.8%) patients developed a recurrent hip infection within 2 years. Therefore, poor outcomes occurred in 22% (n = 11) of the study cohort. Among the 38 patients with a destructive hip joint, 7 (18.4%) died within 1 year after surgery and 4 (10.5%) developed a recurrent hip infection within 2 years of surgery. Correlative infections other than infected hip joint and liver cirrhosis were identified as risk factors for poor outcomes.In conclusion, clinical physicians treating adult primary septic hip joints should be cognizant of the high failure rate of surgical treatment. In addition, the high mortality rate should be considered during the discussion of surgical treatment with these patients and their families.
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Affiliation(s)
- Feng-Chen Kao
- Department of Orthopedics, E-Da Dachang Hospital
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung
| | - Yao-Chun Hsu
- School of Medicine, Big Data Research Center, Fu-Jen Catholic University
- Division of Gastroenterology, Fu-Jen Catholic University Hospital, New Taipei
- Graduate Institute of Clinical Medicine, China Medical University, Taichung
- Division of Gastroenterology and Hepatology, E-Da Hospital
| | - Pao-Hsin Liu
- Department of Biomedical Engineering, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yuan-Kun Tu
- Department of Orthopedics, E-Da Dachang Hospital
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung
| | - I-Ming Jou
- Department of Orthopedics, E-Da Dachang Hospital
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung
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Saiz AM, Lum ZC, Pereira GC. Etiology, Evaluation, and Management of Dislocation After Primary Total Hip Arthroplasty. JBJS Rev 2019; 7:e7. [DOI: 10.2106/jbjs.rvw.18.00165] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Li W, Fang X, Zhang C, Xu Y, Huang Z, Yu Z, Zhang W. Comparison of efficacy and complications between two types of staging arthroplasty in treating chronic septic hip arthritis: A retrospective clinical study. Exp Ther Med 2019; 17:4123-4131. [PMID: 30988789 PMCID: PMC6447925 DOI: 10.3892/etm.2019.7430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/21/2019] [Indexed: 01/09/2023] Open
Abstract
Septic hip arthritis is a rare but serious disease, which is often persistent, able to transform into a chronic infection, and difficult to cure. The present study aimed to compare the midterm outcomes between the staging of a total hip arthroplasty via the Girdlestone surgery (a resection of the head and neck) and the Girdlestone combined with a cement spacer in treating chronic septic hip arthritis, as well as to compare the postsurgery efficacy and complications between the two groups. A total of 13 patients (14 total hip joints) were enrolled and retrospectively analyzed. For the stage I surgery, four patients (five hips) underwent the resection of the head and neck, and nine patients (nine hips) underwent the resection of the head and neck combined with the implantation of a bone cement spacer. After the infection was fully controlled, the patients in both groups underwent cementless total hip arthroplasties as stage II surgeries. The mean follow-up period was 24.2 months. The curative effects and complications of the patients were recorded and compared. It was found that the application of the staging arthroplasty for treating a chronic septic hip was conducive to the complete clearance of lesions. Notably, the implantation of a bone cement spacer containing antibiotics in the stage I surgery prevented joint contracture caused by a head and neck resection, reducing the risk of infection recurrence between the two stages of the operation. This effectively maintained the length of the lower limbs, simplified the stage II complete hip arthroplasty and reduced operative hemorrhage, thus achieving improved recovery of joint function after the stage II arthroplasty. The results suggested that the implantation of a cement spacer at the stage I surgery was more effective in treating chronic septic hip arthritis.
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Affiliation(s)
- Wenbo Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Xinyu Fang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Chaofan Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China.,Department of Orthopedics and Traumatology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, SAR 999077, P.R. China
| | - Yejun Xu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Zida Huang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Zibo Yu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Wenming Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
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Fagotti L, Tatka J, Salles MJC, Queiroz MC. Risk Factors and Treatment Options for Failure of a Two-Stage Exchange. Curr Rev Musculoskelet Med 2018; 11:420-427. [PMID: 29934884 PMCID: PMC6105486 DOI: 10.1007/s12178-018-9504-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Although a two-stage exchange revision is reported to have a high success rate, this strategy may fail as a treatment for prosthetic joint infection (PJI). When it does, resection arthroplasty, arthrodesis, amputation, and chronic antibiotic suppression may play a role. The purpose of this review is to determine which are the main risk factors for a two-stage exchange failure and to analyze the indications and results of resection arthroplasty, arthrodesis, amputation, and antibiotic chronic suppression for PJI. RECENT FINDINGS Recent literature demonstrates that the main risk factors for a two-stage exchange failure are as follows: hemodialysis, obesity, multiple previous procedures, diabetes mellitus, corticosteroid therapy, hypoalbuminemia, immunosuppression, rheumatological conditions, coagulation disorders, and infection due to multidrug-resistant (MDR) bacteria or fungal species. Regarding microorganisms, besides Staphylococcus aureus, Streptococcus spp., Enterobacteriaceae species such as Klebsiella pneumoniae and Enterobacter sp., Pseudomonas aeruginosa, or Acinetobacter baumannii, and fungus including Candida sp. are also considered risk factors for a two-stage exchange failure. Resection arthroplasty, arthrodesis, and amputation have a limited role. Chronic suppression is an option for high-risk patients or unfeasible reconstruction. In summary, we report the main risk factors for a two-stage exchange failure and alternative procedures when it occurs. Future research on patient-specific risk factors for a two-stage exchange may aid surgical decision-making and optimization of outcomes.
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Affiliation(s)
| | - Jakub Tatka
- Steadman Philippon Research Institute, Vail, CO, USA
| | - Mauro Jose Costa Salles
- Division of Infectious Diseases, Department of Internal Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Marcelo C Queiroz
- Department of Orthopaedic Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
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Curtis W, Marmor M. Resection Arthroplasty Compared With Total Hip Arthroplasty in Treating Chronic Hip Pain of Patients With a History of Substance Abuse. J Arthroplasty 2018; 33:2560-2565. [PMID: 29666030 DOI: 10.1016/j.arth.2018.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/06/2018] [Accepted: 03/08/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Retrospective comparison of surgical management of severe hip pain in patients with a history of substance abuse treated by modified Girdlestone resection arthroplasty (RA) vs delayed total hip arthroplasty (THA) following yearlong sobriety pathway. METHODS Patients were identified using charts, current procedural terminology (CPT) code query, and THA sobriety pathway registry. The primary outcome was adequate pain control following surgery, defined as visual analog scale ≤ 5 or verbal description of "moderate" or lower pain. RA patients with infectious arthritis were analyzed separately. The secondary outcome was the level of mobility after surgery. RESULTS In the THA pathway, 15 of 28 (53.6%) proved sobriety, 11 (39.3%) underwent THA, and 9 (32.1%) achieved adequate pain control (median 77 days). After RA, 19 (76%) achieved adequate pain control (median 119.5 days). Preoperative infection did not significantly affect time to pain control after RA (P = .94). Time to adequate pain control was not significantly different between RA and THA patients (P = .19). Three patients (30%) experienced improved level of mobility after THA and 7 (70%) experienced no change. After RA, 7 patients (29.1%) experienced improved level of mobility, 3 (13.6%) lost mobility, and 14 (63.6%) experienced no change. Three RA patients were later converted to THA without complication. CONCLUSION Yearlong sobriety pathway leading to THA leads to successful pain control in less than one-third of enrolled patients. Compared to delayed THA, RA enables more patients with substance abuse to be treated sooner and results in successful reduction of pain in a similar proportion of patients. RA may be an effective pain-reducing procedure for these patients.
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Affiliation(s)
- William Curtis
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Meir Marmor
- Department of Orthopaedic Surgery, University of California, San Francisco, Orthopaedic Trauma Institute, San Francisco, California
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Ikebe S, Sonohata M, Kitajima M, Kawano S, Mawatari M. Total hip arthroplasty following Girdlestone arthroplasty. J Orthop Sci 2018; 23:532-537. [PMID: 29459080 DOI: 10.1016/j.jos.2018.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/02/2018] [Accepted: 01/28/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Complications associated with re-implantation of total hip arthroplasty (THA) after resection arthroplasty for the treatment of primary septic hip arthritis or infected THA and bipolar hemiarthroplasty (BHA) are not well-documented. Furthermore, no comparison has been made between septic arthritis (SA) and infected THA and BHA. We divided subjects into two groups for evaluation: a SA group and an infected THA or BHA group. METHODS Nineteen hips in 19 patients (12 in the SA group, 7 in the infected THA or BHA group) with an average of 77 months of follow-up from the time of re-implantation THA were retrospectively evaluated. RESULTS The average Japanese Orthopaedic Association hip score improved from 50 points (range, 30 to 73 points) preoperatively to 80 points (range: 64 to 96 points) at the time of the final follow-up (p < 0.01). Intra- and postoperative complications occurred in 11 cases, including intraoperative fracture in 1 hip, deep infection in 6 hips, dislocation in 7 hips, and septic loosening of acetabular component in 2 hips. Following re-implantation, further surgical revision was required in four cases. Two revisions were performed for recurrent infection: one patient had recurrent dislocation of one hip, and one patient had recurrent infection and dislocation. The number of hips with relapsed infection in the infected THA or BHA group (5 hips) was significantly higher than that in the SA group (1 hip) (p < 0.05). CONCLUSIONS Re-implantation after septic hip arthritis or infected THA or BHA was an effective treatment for improving the activity of daily life, especially the gait function. Furthermore, 94.7% of patients were free of infection at the latest follow-up. However, the rate of recurrence of infection was 31.6%, and re-implantation after resection arthroplasty following infected THA or BHA led to a lower rate of infection control than that after primary SA.
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Affiliation(s)
- Satoshi Ikebe
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan.
| | - Masaru Kitajima
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Shunsuke Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
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Mahmoud SSS, Sukeik M, Alazzawi S, Shaath M, Sabri O. Salvage Procedures for Management of Prosthetic Joint Infection After Hip and Knee Replacements. Open Orthop J 2016; 10:600-614. [PMID: 28144373 PMCID: PMC5226968 DOI: 10.2174/1874325001610010600] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/24/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023] Open
Abstract
Background: The increasing load placed by joint replacement surgery on health care systems makes infection, even with the lowest rates, a serious concern that needs to be thoroughly studied and addressed using all possible measures. Methods: A comprehensive review of the current literature on salvage procedures for recurrent PJIs using PubMed, EMBASE and CINAHL has been conducted. Results: Prolonged suppressive antibiotic therapy (PSAT), resection arthroplasty and arthrodesis were the most common procedures performed. Suppressive antibiotic therapy is based on the use of well tolerated long term antibiotics in controlling sensitive organisms. Resection arthroplasty which should be reserved as a last resort provided more predictable outcomes in the hip whereas arthrodesis was associated with better outcomes in the knee. Various methods for arthrodesis including internal and external fixation have been described. Conclusion: Despite good union and infection control rates, all methods were associated with complications occasionally requiring further surgical interventions.
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Affiliation(s)
- Samer S S Mahmoud
- Department of Trauma and Orthopaedics, South Tees NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3 BW, United Kingdom
| | - Mohamed Sukeik
- Department of Trauma and Orthopaedics, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
| | - Sulaiman Alazzawi
- Department of Trauma and Orthopaedics, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
| | - Mohammed Shaath
- Department of Trauma and Orthopaedics, North Manchester General Hospital, Delaunay's Road, Crumpsall, M8 5RB, United Kingdom
| | - Omar Sabri
- Department of Trauma and Orthopaedics, St Georges NHS Foundation Trust, Tooting, London, SW17 0QT, United Kingdom
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Anagnostakos K, Duchow L, Koch K. Two-stage protocol and spacer implantation in the treatment of destructive septic arthritis of the hip joint. Arch Orthop Trauma Surg 2016; 136:899-906. [PMID: 27098293 DOI: 10.1007/s00402-016-2455-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The ideal treatment of the destructive septic arthritis of the hip joint remains controversial. The aim of the present retrospective study was to report on our experience about the use of antibiotic-loaded cement spacers in the treatment of destructive bacterial coxitis. MATERIALS AND METHODS 22 consecutive patients (11 male, 11 female, mean age 59.7 years) have been treated with a two-stage protocol and implantation of an antibiotic-loaded cement spacer. All patients' records have been retrospectively evaluated with regard to comorbidities/predisposing factors, infection cause, causative pathogen organism, presence of a psoas abscess, surgical time of spacer implantation, duration of spacer implantation, spacer articulation, impregnation of bone cement, systemic antibiotic therapy, surgical time of prosthesis implantation, implant type, complications, and infection control rate. RESULTS The most common identified organism was Staphylococcus aureus (73 %). The mean duration of spacer implantation was 88 days. Spacer-specific complications were observed in 23 % of the cases and spacer non-specific ones in 50 % between stages. The mortality rate after the first stage was 18 %. Prosthesis implantation was performed in 16 cases. At a mean follow-up of 44.8 (12-120) months, the primary infection control rate (after one spacer implantation) was 87 % (13/15) and the secondary infection control rate (after two spacer implantations) 100 %. CONCLUSIONS Two-stage treatment and spacer implantation is associated with a high rate of infection control but also with a high mortality rate between stages.
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Affiliation(s)
- Konstantinos Anagnostakos
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstr. 100, 66421, Homburg, Saar, Germany.
| | - Luise Duchow
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstr. 100, 66421, Homburg, Saar, Germany
| | - Katrin Koch
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstr. 100, 66421, Homburg, Saar, Germany
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Vaishya R, Vijay V, Vaish A. Successful salvage of an unstable Girdlestone's excision arthroplasty with a megaprosthesis of the hip. J Clin Orthop Trauma 2015; 6:269-72. [PMID: 26566342 PMCID: PMC4600883 DOI: 10.1016/j.jcot.2015.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/16/2015] [Indexed: 11/28/2022] Open
Abstract
The functional results after a Girdlestone's excision arthroplasty of the hip are unpredictable with high patient dissatisfaction and complication rates. We report such a case of symptomatic patient, which was managed successfully with a megaprosthesis of the hip with constrained acetabular liner. The use of megaprosthesis for a failed and symptomatic Girdlestone's excision arthroplasty of the hip has not been reported before.
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Affiliation(s)
- Raju Vaishya
- Senior Consultant, Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110067, India
| | - Vipul Vijay
- Consultant, Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110067, India,Corresponding author. Tel.: +91 9811723671 (mobile).
| | - Abhishek Vaish
- Student, Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110067, India
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28
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Two-stage revision of an infected total hip arthroplasty: a follow-up of 136 patients. Hip Int 2015; 23:445-50. [PMID: 23813178 DOI: 10.5301/hipint.5000049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Periprosthetic infection of a total hip arthroplasty (THA) is commonly treated with a two-stage revision procedure. After resection of the infected THA and placement of a cement spacer loaded with antibiotics, a THA is inserted at a second procedure to restore hip function and mobility. Revision surgery carries a significant risk of complications. This study focuses on hip function, rate of complications and reinfection after two-stage revision surgery for an infected THA. PATIENTS AND METHODS From January 1996 to April 2010, 136 patients underwent revision surgery after removal of an infected THA. Follow-up ranged from 2 years to more than 15 years. Hip function was evaluated using the modified Harris Hip Score (mHHS) and the Hip disability and Osteoarthritis Outcome Score (HOOS). Visual Analogue Scale (VAS) measured pain. Annual follow-up included radiographs of the affected hip and blood sampling for inflammatory parameters. RESULTS After revision surgery, average mHHS was 63% and average HOOS was 54%. VAS pain averaged 26.8 on a 100-point scale and 40% of patients had no pain. Prosthesis-related complications unrelated to sepsis occurred in 32%. Most common were periprosthetic fractures, leg length discrepancy and dislocation. Reinfection occurred in 13% of these patients and Coagulase Negative Staphylococcus (CNS) was isolated in 67%. CONCLUSION Two-stage evision surgery is an accepted treatment for infected THAs. However, complications are common and hip function afterwards is modest. As previous studies have shown, CNS is an important microorganism in reinfection.
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Garcia-Rey E, Cruz-Pardos A, Madero R. Clinical outcome following conversion of Girdlestone's resection arthroplasty to total hip replacement: a retrospective matched case-control study. Bone Joint J 2015; 96-B:1478-84. [PMID: 25371460 DOI: 10.1302/0301-620x.96b11.33889] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A total of 31 patients, (20 women, 11 men; mean age 62.5 years old; 23 to 81), who underwent conversion of a Girdlestone resection-arthroplasty (RA) to a total hip replacement (THR) were compared with 93 patients, (60 women, 33 men; mean age 63.4 years old; 20 to 89), who had revision THR surgery for aseptic loosening in a retrospective matched case-control study. Age, gender and the extent of the pre-operative bone defect were similar in all patients. Mean follow-up was 9.3 years (5 to 18). Pre-operative function and range of movement were better in the control group (p = 0.01 and 0.003, respectively) and pre-operative leg length discrepancy (LLD) was greater in the RA group (p < 0.001). The post-operative clinical outcome was similar in both groups except for mean post-operative LLD, which was greater in the study group (p = 0.003). There was a significant interaction effect for LLD in the study group (p < 0.001). A two-way analysis of variance showed that clinical outcome depended on patient age (patients older than 70 years old had worse pre-operative pain, p = 0.017) or bone defect (patients with a large acetabular bone defect had higher LLD, p = 0.006, worse post-operative function p = 0.009 and range of movement, p = 0.005), irrespective of the group. Despite major acetabular and femoral bone defects requiring complex surgical reconstruction techniques, THR after RA shows a clinical outcome similar to those obtained in aseptic revision surgery for hips with similar sized bone defects.
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Affiliation(s)
- E Garcia-Rey
- Department of Biostatistics, Hospital Universitario La Paz- Idi Paz, Castellana 261, 28046 Madrid, Spain
| | - A Cruz-Pardos
- Department of Biostatistics, Hospital Universitario La Paz- Idi Paz, Castellana 261, 28046 Madrid, Spain
| | - R Madero
- Department of Biostatistics, Hospital Universitario La Paz- Idi Paz, Castellana 261, 28046 Madrid, Spain
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30
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Rubin LE, Murgo KT, Ritterman SA, McClure PK. Hip Resection Arthroplasty. JBJS Rev 2014; 2:01874474-201405000-00003. [PMID: 27500608 DOI: 10.2106/jbjs.rvw.m.00060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Lee E Rubin
- University Orthopedics, Inc., Medical Office Center, 2 Dudley Street, Suite 200, Providence, RI 02905
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Gil Gonzalez S, Marqués López F, Rigol Ramon P, Mestre Cortadellas C, Cáceres Palou E, León García A. Two-stage revision of hip prosthesis infection using a hip spacer with stabilising proximal cementation. Hip Int 2014; 20 Suppl 7:S128-34. [PMID: 20512784 DOI: 10.1177/11207000100200s721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2010] [Indexed: 02/04/2023]
Abstract
Two-stage revision hip arthroplasty for infection using an antibiotic-loaded cement spacer has been used frequently with good results. However, spacer instability is also frequent. Proximal cementation of the spacer could avoid spacer dislocation. We retrospectively assessed 35 patients in whom a 2-stage revision hip arthroplasty for infection was carried out using an antibiotic-loaded cement spacer with gentamicin (Spacer-G) in which the spacer was proximally cemented in 16 patients. The mean follow-up was 32 months. We assessed spacer stability and infection elimination. There were 8 spacer dislocations (22.9%), 5 in hips without proximal cementation and 2 in hips with proximal cementation (p>0.05). There was no fracture in any hip. Reinfection occurred in 5 hips (14.3%), in 3 with the same microorganism, while 2 had a different microorganism. Our results indicate that the proximal cementation of the spacer prevents its dislocation. Infection was eliminated in 86% of the hips.
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Affiliation(s)
- Sergi Gil Gonzalez
- Orthopaedic Surgery Department, Hospitales del Imas, Mar y Esperanza, Universitat Autónoma de Barcelona, Barcelona, Spain
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Shen H, Wang QJ, Zhang XL, Jiang Y. Novel articulating medullary-sparing spacer for the treatment of infectious hip arthritis. Orthopedics 2013; 36:e404-8. [PMID: 23590777 DOI: 10.3928/01477447-20130327-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Two-stage total hip arthroplasty (THA) is considered a safe choice for the treatment of primary infectious arthritis of the hip. In cases where the proximal portion of the femur is intact without infection, the use of a spacer with a femoral stem during the interim would disturb the normal femoral medullary cavity. The authors report the technical procedure and outcomes of cases using a novel medullary sparing, antibiotic-loaded hip spacer for the treatment of hip infections.Five consecutive patients (5 hips) with infectious arthritis of the hip were treated in a 2-stage approach using an intraoperatively made medullary-sparing hip spacer. During the first-stage THA, after thorough debridement of potentially infected and necrotic soft tissues, the spacer was inserted into the femoral neck and fixed without opening the femoral canal. Antibiotics were administered for at least 6 weeks and were continued until the infection was controlled clinically, after which the second-stage THA was completed.Infection was eradicated in all 5 hips. Average follow-up was 39.6 months (range, 30-59 months). At most recent follow-up, no recurrence of infection was observed. No specific complications were associated with the use of this novel spacer. Average Harris Hip Score improved from 35.2 (range, 28-43) before the first-stage THA to 61.6 (range, 54-71) between the 2 stages and to 93.6 (range, 89-99) at final follow-up. All patients ambulated with the aid of crutches during the interim period.
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Affiliation(s)
- Hao Shen
- Department of Orthopaedic Surgery, Division of Adult Reconstruction, Shanghai No. 6th Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Republic of China.
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Dunn J, Scully WF, Crawford DA, Manoso MW. Ipsilateral diaphyseal femur fracture after resection arthroplasty. J Arthroplasty 2012; 27:1580.e17-9. [PMID: 22386608 DOI: 10.1016/j.arth.2012.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 01/20/2012] [Indexed: 02/01/2023] Open
Abstract
Resection arthroplasty of the hip is most commonly used for recalcitrant infections in the setting of prior hemiarthroplasty and total hip arthroplasty. Reported complications of this procedure include shortening of the extremity and ambulation difficulties requiring assistive devices. We report a case of an unusual finding of an ipsilateral femoral shaft fracture after a ground level fall 4 months after a resection arthroplasty for a septic hip. A closed reduction with internal fixation using an intramedullary nail was performed, and 3 months postoperatively, the patient was ambulating with device assistance.
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Affiliation(s)
- John Dunn
- William Beaumont Army Medical Center and Texas Tech University Health Sciences Center, El Paso, TX, USA
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34
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Fleck EE, Spangehl MJ, Rapuri VR, Beauchamp CP. An articulating antibiotic spacer controls infection and improves pain and function in a degenerative septic hip. Clin Orthop Relat Res 2011; 469:3055-64. [PMID: 21519937 PMCID: PMC3183191 DOI: 10.1007/s11999-011-1903-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treating septic arthritis of the hip with coexisting advanced degenerative disease is challenging. The use of primary total hip arthroplasty (THA) has led to postoperative infection rates as high as 22%. Insertion of antibiotic spacers with subsequent reimplantation of a THA controls infection and improves pain and function in patients with periprosthetic infections. QUESTIONS/PURPOSES We asked whether two-stage exchange for patients with degenerative joint disease (DJD) and coexisting septic arthritis would control infection and improve pain relief and function both during the period after insertion of the spacer and after conversion to THA. METHODS We retrospectively reviewed 14 patients with severe DJD and either active or recent septic arthritis treated with débridement and insertion of a primary antibiotic-loaded cement spacer between 1996 and 2008. Ten patients underwent subsequent exchange to a permanent hip arthroplasty. Four patients did not undergo exchange to a permanent THA: two died from unrelated causes and two elected not to proceed with exchange because their spacer provided adequate function. We obtained a modified Harris hip score. The minimum clinical followup was 7 months (average, 28 months; range, 7-65 months) after insertion of the spacer. RESULTS Mean pain scores improved from 6 to 34, and overall Harris hip scores improved from 11 to 67 at last followup with the spacer. Those who underwent definitive THA had further improvement in their mean Harris hip scores to 93. CONCLUSIONS Articulating antibiotic spacers offer acceptable pain relief and function while the infection is treated in this unique group of patients. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Erin E. Fleck
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, 5777 Mayo Boulevard, Phoenix, AZ 85054 USA
| | - Mark J. Spangehl
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, 5777 Mayo Boulevard, Phoenix, AZ 85054 USA
| | - Venkat R. Rapuri
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, 5777 Mayo Boulevard, Phoenix, AZ 85054 USA
| | - Christopher P. Beauchamp
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, 5777 Mayo Boulevard, Phoenix, AZ 85054 USA
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[Hip joint infections - Results of a questionnaire among 28 university orthopedic departments]. DER ORTHOPADE 2011; 40:781-92. [PMID: 21837461 DOI: 10.1007/s00132-011-1785-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Despite numerous prophylactic measures infections still remain a hazardous complication in orthopedic surgery. MATERIAL AND METHODS A questionnaire about hip joint infections was sent to all university orthopedic departments in Germany and Austria. The questionnaire included 33 questions with respect to demographic data, causative organisms, diagnostic measures, treatment options for early and late infections, antibiotic therapy and prosthesis reimplantation. RESULTS The participation rate was 70%. The most frequent primary surgical indication was primary total hip replacement and Staphylococcus aureus and S. epidermidis were the most common pathogens identified. All departments performed a joint aspiration for diagnosis confirmation but for other diagnostic measures a great discrepancy could be observed. In the treatment of early infections removable components were always exchanged, whereas a local antibiotic therapy was not always employed. With regard to late infections a two-stage protocol was more frequently used than a one-stage treatment, whereby the implantation of a cement spacer was more commonly performed than a resection arthroplasty. The time between stages varied between 6 and 12 weeks and systemic antibiotics were administered for a mean time of 6 weeks. For prosthesis reimplantion cementless components were mostly used but no clear tendency could be determined for systemic antibiotic therapy. CONCLUSION Treatment of hip joint infections among German and Austrian university orthopedic departments is only partly carried out in a similar manner.
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Romanò CL, Romanò D, Meani E, Logoluso N, Drago L. Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study. BMC Infect Dis 2011; 11:129. [PMID: 21575241 PMCID: PMC3118141 DOI: 10.1186/1471-2334-11-129] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 05/16/2011] [Indexed: 01/31/2023] Open
Abstract
Background Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol. Methods Nineteen patients (20 hips) were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS]) and hip joint function (Harris Hip score). Results The mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104) months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84) pre-operatively to 18 (range, 0 - 38) prior to spacer removal and to 8 (range, 0 - 15) at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment. Conclusions Satisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.
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Affiliation(s)
- Carlo L Romanò
- Dipartimento di Chirurgia Ricostruttiva e delle Infezioni Osteo-articolari Istituto Ortopedico I,R,C,C,S, Galeazzi, Milano, Italy.
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Anagnostakos K, Jung J, Kelm J, Schmitt E. Two-stage treatment protocol for isolated septic acetabular cup loosening. Hip Int 2010; 20:320-6. [PMID: 20640998 DOI: 10.1177/112070001002000305] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2010] [Indexed: 02/06/2023]
Abstract
The aim of this study was to evaluate the treatment of isolated septic acetabular cup loosening without involvement of the prosthesis stem by insertion of an antibiotic-loaded spacer head and stem retention. Between 1999 and 2008, 13 patients (5 men, 8 women, mean age 69 years) were treated according to this regimen. S. epidermidis and S. aureus were the two most commonly identified pathogens. In 12 cases the polymethylmethacrylate spacers were impregnated with 0.5 g gentamicin + 2 g vancomycin per 40 g bone cement, except in one patient with vancomycin allergy, in whom 0.5 g gentamicin + 0.4 g teicoplanin were used. The spacers acted as hemiarthroplasties. The mean spacer head implantation time was 88 (35-270) days. At a mean follow-up of 55 (12-83) months, infection eradication was achieved in 11 out of 12 cases (91.6%). Complications included a draining sinus, and one spacer and one definitive prosthesis dislocation. One patient died after reimplantation due to cardiopulmonary decompensation.
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Affiliation(s)
- Konstantinos Anagnostakos
- Department of Orthopaedics and Orthopaedic Surgery, University Hospitals of Saarland, Homburg/Saar, Germany.
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Treatment of periprosthetic hip infection caused by resistant microorganisms using 2-stage reimplantation protocol. J Arthroplasty 2009; 24:1264-9. [PMID: 19523784 DOI: 10.1016/j.arth.2009.05.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Accepted: 05/05/2009] [Indexed: 02/01/2023] Open
Abstract
To determine the effectiveness of staged reimplantation for the treatment of periprosthetic hip infection caused by resistant microorganisms, we performed a retrospective case-control study on 37 consecutive patients who had a culture-proven periprosthetic hip infection treated using a 2-stage reimplantation protocol. Twenty-four patients infected by resistant microorganisms were compared with 13 patients infected by nonresistant microorganisms. The second-stage reimplantation procedure was possible in 34 (92%) of the 37 patients, but the remaining 3 required permanent resection because of persistent infection. At a mean follow-up of 4.4 years, there were 4 recurrent infections and 1 aseptic cup loosening. Overall treatment failure rate was 22%. All failures occurred only in the resistant microorganism group and none in the nonresistant microorganism group (33% vs 0%; P = .032). Current 2-stage reimplantation protocol showed a high rate of treatment failure in our patients with a periprosthetic hip infection caused by resistant microorganisms.
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Prevention of dislocation in total hip revision surgery using a dual mobility design. Orthop Traumatol Surg Res 2009; 95:407-13. [PMID: 19656750 DOI: 10.1016/j.otsr.2009.04.016] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 11/02/2008] [Accepted: 04/21/2009] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postoperative dislocation is the commonest complication following revision total hip arthroplasty (THA). HYPOTHESIS AND TYPE OF STUDY: Dual mobility cups are supposed to reduce the risk of THA instability. The present retrospective study tested this hypothesis on revision THAs and also, assessed this design contribution to acetabular fixation longevity. MATERIALS AND METHODS The series was homogeneous and continuous, comprising a total of 163 revision THAs: 110 of them were bipolar revisions and 53 were restricted to the acetabular component exchange. Mean patient age was 68.7 years (range: 34-92 years). Novae (SERF, Décines) dual mobility cups were used in all cases: 110 cementless cups were used and 53 cups were cemented in a Kerboull reinforcement ring due to severe acetabular bone loss. RESULTS Mean patients' follow-up (FU) was 60.4 + or - 17.6 months. There were six early dislocations (which were reduced without additional surgery and remained recurrence-free) and two cases of acetabular loosening. The total postoperative dislocation rate at the end of follow-up was 3.7% and the 7-year cup survivorship rate was 96.1% (95% CI: 92.8-99.2%). In revision for aseptic loosening, the instability rate was 2.9%; in the higher instability risk groups (i.e., revision for infection and or recurrent instability) the dislocation rate was respectively 9% and 0%. DISCUSSION Dual mobility cups provided a dislocation rate of only 3.7% in revision THA, comparable to the one reported with standard implants for primary THA. This kind of cup design is especially suited to deal with high instability risk revision cases, where constrained components are generally recommended. It can also be indicated in cases of aseptic loosening, where it resulted in a 2.9% dislocation rate and only two impending failures of fixation. In terms of mechanical failure rate, these numbers compare well to the ones pertaining to tripolar and constrained implants. These later alternatives remain possible options but are not fully efficient in terms of long-term stability and fixation longevity. LEVEL OF STUDY: Level IV, retrospective or records-based.
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Jung J, Schmid NV, Kelm J, Schmitt E, Anagnostakos K. Complications after spacer implantation in the treatment of hip joint infections. Int J Med Sci 2009; 6:265-73. [PMID: 19834592 PMCID: PMC2755123 DOI: 10.7150/ijms.6.265] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 09/01/2009] [Indexed: 02/03/2023] Open
Abstract
The aim of this retrospective study was to identify and evaluate complications after hip spacer implantation other than reinfection and/or infection persistence. Between 1999 and 2008, 88 hip spacer implantations in 82 patients have been performed. There were 43 male and 39 female patients at a mean age of 70 [43-89] years. The mean spacer implantation time was 90 [14-1460] days. The mean follow-up was 54 [7-96] months. The most common identified organisms were S. aureus and S. epidermidis. In most cases, the spacers were impregnated with 1 g gentamicin and 4 g vancomycin/80 g bone cement. The overall complication rate was 58.5% (48/82 cases). A spacer dislocation occurred in 15 cases (17%). Spacer fractures could be noticed in 9 cases (10.2%). Femoral fractures occurred in 12 cases (13.6%). After prosthesis reimplantation, 16 patients suffered from a prosthesis dislocation (23%). 2 patients (2.4%) showed allergic reactions against the intravenous antibiotic therapy. An acute renal failure occurred in 5 cases (6%). No cases of hepatic failure or ototoxicity could be observed in our collective. General complications (consisting mostly of draining sinus, pneumonia, cardiopulmonary decompensation, lower urinary tract infections) occurred in 38 patients (46.3%). Despite the retrospective study design and the limited possibility of interpreting these findings and their causes, this rate indicates that patients suffering from late hip joint infections and being treated with a two-stage protocol are prone to having complications. Orthopaedic surgeons should be aware of these complications and their treatment options and focus on the early diagnosis for prevention of further complications. Between stages, an interdisciplinary cooperation with other facilities (internal medicine, microbiologists) should be aimed for patients with several comorbidities for optimizing their general medical condition.
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Affiliation(s)
- Jochen Jung
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätskliniken des Saarlandes, Homburg/Saar, Germany.
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Brinker MR, Mathews V, O'Connor DP. Ilizarov distraction before revision hip arthroplasty after resection arthroplasty with profound limb shortening. J Arthroplasty 2009; 24:826.e17-23. [PMID: 18701247 DOI: 10.1016/j.arth.2008.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 05/02/2008] [Indexed: 02/01/2023] Open
Abstract
We report the results of Ilizarov gradual distraction to regain 6.7 cm of leg length in a severely contracted hip 11 months after a resection arthroplasty. Restoration of leg length allowed revision hip arthroplasty. At 24 months after the revision arthroplasty, the patient is ambulating independently and pain free. The use of Ilizarov gradual distraction restored leg length and facilitated postoperative function.
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Affiliation(s)
- Mark R Brinker
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, Texas 77030-4509, USA
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Static and mobile antibiotic-impregnated cement spacers for the management of prosthetic joint infection. J Am Acad Orthop Surg 2009; 17:356-68. [PMID: 19474445 DOI: 10.5435/00124635-200906000-00004] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Two-stage treatment is currently the most common approach for management of an infected joint prosthesis in the United States. Static antibiotic-impregnated polymethylmethacrylate cement spacers have traditionally been used; increasingly, however, mobile or articulating spacers are being utilized. Advocates of mobile spacers have cited potential advantages, including more effective maintenance of the joint space, allowing for limited weight bearing and facilitating joint motion; possible reduction in bone loss; and local delivery of antibiotics. Because a variety of materials and construction methods is used to make knee and hip spacers, comparisons are difficult. Randomized, prospective studies are needed to determine the best spacers for total knee and total hip arthroplasties.
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Diwanji SR, Kong IK, Park YH, Cho SG, Song EK, Yoon TR. Two-stage reconstruction of infected hip joints. J Arthroplasty 2008; 23:656-61. [PMID: 18534541 DOI: 10.1016/j.arth.2007.06.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 06/18/2007] [Indexed: 02/01/2023] Open
Abstract
Two-stage reconstruction using an antibiotic-loaded cement spacer is the preferred treatment of deep infection after total hip arthroplasty (THA). We evaluated the results of this technique for the treatment of primary hip infections. Nine consecutive patients with infected hip joints were treated using this technique. The average duration of follow-up was 42 months. Debridement and insertion of an antibiotic-loaded cement spacer was performed in the first stage. After eradication of infection, it was converted to THA in the second stage. Of the 9 hips, 8 were successfully converted to THA after an average of 23 weeks. One patient required spacer reinsertion, and another experienced reinfection after THA. Average Harris hip score improved from 38.37 before surgery to 57.62 between the 2 stages to 97.83 at final follow-up. Two-stage reconstruction using an antibiotic-loaded cement spacer was found to give satisfactory results for the treatment of hip infections with various etiologies.
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Affiliation(s)
- Sanket R Diwanji
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160 Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam 519-809, Korea
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Emara KM. Pelvic support osteotomy in the treatment of patients with excision arthroplasty. Clin Orthop Relat Res 2008; 466:708-13. [PMID: 18264860 PMCID: PMC2505230 DOI: 10.1007/s11999-007-0094-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 12/03/2007] [Indexed: 01/31/2023]
Abstract
Resistant hip infection in adults can be a complicated problem that does not respond to surgical and medical treatment. In such cases, the only remaining option is excision arthroplasty. This line of treatment can eradicate the infection but also is associated with poor function. In some cases, conversion of excision arthroplasty to artificial joint replacement is associated with too great a risk because of local hip surgical risks or low immunity with risk of recurrent infection. Pelvic support osteotomy with the Ilizarov modification can present an alternative solution for such patients. This study included 11 patients with resistant hip infection who were treated using excision arthroplasty. Pelvic support osteotomy then was used to improve hip stability and abductor muscle function. The Ilizarov modification was applied to correct mechanical alignment of the limb and the limb length discrepancy. Harris hip scores improved in all patients: the average score preoperatively was 43.5 (range, 31-50), whereas at final followup, the average score was 70.9 (range, 65-80). Pelvic support osteotomy, along with the Ilizarov modification, can provide an alternative treatment to improve function in patients previously managed with excision hip arthroplasty and Girdlestone surgery.
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Affiliation(s)
- Khaled Mohamed Emara
- Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, 13 B Kornesh El Nile, Agha Khan, Cairo, Egypt
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Abstract
With an increasing number of people immigrating between different countries, sickle cell disease (SCD) is spreading all over the world. Due to improved health care, the life span of SCD patients has increased and many of them live to adulthood and middle-age. Osteonecrosis of the femoral head is one of the most common musculo-skeletal problems in SCD patients. Once osteonecrosis starts in the femoral head, it can progress from early to late stages in just a few years. Managing osteonecrosis of the femoral head in young-adults is a challenging problem and, in many situations, it requires major surgical procedures. In the early stages of the disease it is advisable to treat it by femoral head preserving procedures. In advanced stages, hip replacement arthroplasty (HPA) is indicated. In SCD patients, the incidence of operative complications and failure rates are higher than that for osteonecrosis due to other causes. Understanding the problems of SCD patients; appropriate diagnosis, prognosis, implications of the procedure performed and taking the necessary precautions, can reduce the complications and delay the failure of surgical procedures.
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Fehring TK, Odum S, Struble S, Fehring K, Griffin WL, Mason JB. Hip instability in 2-stage reimplantation without an articulating spacer. J Arthroplasty 2007; 22:156-61. [PMID: 17823036 DOI: 10.1016/j.arth.2007.03.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 03/27/2007] [Indexed: 02/01/2023] Open
Abstract
Hip instability is a common postoperative complication after revision surgery. This study sought to define the prevalence of hip instability after 2-stage reimplantation without an articulating spacer. A joint registry review identified 110 patients undergoing 2-stage reimplantation. Fifty-five patients (56 hips) were alive at the time of data collection. Instability was documented and risk factors were analyzed. Of the 56 hips, 14 (25%) dislocated. Five of these 14 patients had chronic abduction insufficiency. Six patients required rerevision to attain stability. There were no significant differences between dislocators and nondislocators in abduction angle, head size, cup size, liner type, or leg length. The 25% (14/56) dislocation rate reported here is unacceptable. Interim articulating spacers, postoperative bracing, large head technology, and constrained liners are treatment methods that should be considered in this group of patients.
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Affiliation(s)
- Thomas K Fehring
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina 28207, USA
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Chen CE, Wang JW, Juhn RJ. Total hip arthroplasty for primary septic arthritis of the hip in adults. INTERNATIONAL ORTHOPAEDICS 2007; 32:573-80. [PMID: 17483946 PMCID: PMC2551720 DOI: 10.1007/s00264-007-0366-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 03/28/2007] [Accepted: 03/28/2007] [Indexed: 11/24/2022]
Abstract
Two-stage total hip arthroplasties (THA) performed after primary septic arthritis of hip were studied to evaluate the surgical outcomes and complications. Of 28 cases, the reinfection rate was 14% and complication rate was 36%. At an average follow-up period of 77 months, the outcome in 22 patients (79%) was rated as good or excellent, 4 as fair, and 2 as poor. Leg length discrepancy improved from a preoperative mean of 2.89 cm to a postoperative mean of 0.61 cm. Despite a higher complication rate, two-stage THA was still deemed a worthy procedure because hip function was significantly improved in patients with primary septic arthritis of the hip.
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Affiliation(s)
- Chin-En Chen
- Orthopedic Surgery, Guo Ren Hospital, Pingtung, Taiwan, Republic of China.
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Cabrita HB, Croci AT, Camargo OPD, Lima ALLMD. Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer. Clinics (Sao Paulo) 2007; 62:99-108. [PMID: 17505692 DOI: 10.1590/s1807-59322007000200002] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Accepted: 02/26/2007] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Our purpose was to compare 2 methods of treatment of chronic infection in hip arthroplasties--with or without an antibiotic-loaded cement spacer. METHODS In a prospective study, we treated 68 infected hip arthroplasties with discharging sinuses and bone loss, comparing 30 patients treated in 2 stages without the use of a spacer (control group) and 38 patients treated with a vancomycin-loaded spacer (study group). The average follow-up was 4 years (2-8.5 years). One patient died of unrelated causes 4 months after first-stage surgery and was excluded from the study. RESULTS The 2-stage surgery without spacer controlled the infection in 66.7% of patients, and the 2-stage surgery using the spacer controlled it in 89.1% (P < 0.05). At last follow-up, the average Harris Hip Score increased from 19.3 to 69.0 in the control group versus 19.7 to 75.2 in the study group (P > 0.05). The average leg length discrepancy was 2.6 cm in the control group and 1.5 cm in the study group (P < 0.05). The patients treated with a spacer had better clinical results (81.5% of patients with good results against 60.0% for the control group). CONCLUSION The use of an antibiotic-loaded spacer in the 2-stage treatment of infected hip arthroplasties provides better infection control with good functional results and is superior to treatment in 2 stages without a spacer. LEVEL OF EVIDENCE Therapeutic study, Level I-1.
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Abstract
Dislocation is a well documented complication after a two-stage revision arthroplasty for a deep periprosthetic hip infection. We are aware of no reports specifically evaluating the risk factors for dislocation after reimplantation for infection. We hypothesized greater age, increase in the number of operations on the hip, increase in the length of time from resection to reimplantation, greater limb length discrepancy, smaller femoral offset, and using smaller femoral heads would increase the risk of dislocation. We retrospectively reviewed 34 patients who had a two-stage hip revision for periprosthetic infection with a minimum followup of 2 years. Risk factors for dislocation were evaluated. We compared the rate of dislocation in this group to those patients having revision for aseptic failure. Sixteen dislocations occurred in five (14.7%) of 34 patients. Dislocation occurred in three (1.7%) of 171 patients having revision for aseptic failure. In this small series, age at reimplantation, number of previous operations on the hip, length of time from resection to reimplantation, limb length discrepancy, femoral offset, and femoral head size did not seem to be risk factors for dislocation.
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Affiliation(s)
- Curtis W Hartman
- University of Nebraska Medical Center, Department of Orthopaedic Surgery and Rehabilitation, Omaha, NE 68198-1080, USA.
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Hsieh PH, Chang YH, Chen SH, Shih CH. Staged arthroplasty as salvage procedure for deep hip infection following intertrochanteric fracture. INTERNATIONAL ORTHOPAEDICS 2006; 30:228-32. [PMID: 16673103 PMCID: PMC2532121 DOI: 10.1007/s00264-005-0059-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 11/17/2005] [Accepted: 11/19/2005] [Indexed: 10/24/2022]
Abstract
Deep hip infection is a rare complication of intertrochanteric fractures and an optimal treatment has not yet been reported. Twenty-seven patients who contracted deep hip sepsis following the failed primary treatment of an intertrochanteric fracture were treated with two-stage hip arthroplasty. Antibiotic-impregnated cement beads were implanted following resection arthroplasty in the first 15 patients, and a temporary cement spacer prosthesis was used in the other 12 hips. There was only one recurrence of infection at an average follow-up of 4.8 years. Complications included non-union of the greater trochanter in four patients, intraoperative femoral fracture in two and fracture of the cement prosthesis in one. The use of an interim spacer was associated with better hip function in the interim period; a decreased operative time and less blood loss at the time of arthroplasty; and a higher hip score at final follow-up. Staged arthroplasty is an effective salvage procedure for deep hip infection after the failed treatment of an intertrochanteric fracture. The use of a temporary spacer maintains hip function between stages, makes arthroplasty less complicated, and improves the clinical outcome.
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Affiliation(s)
- Pang-Hsin Hsieh
- Department of Orthopaedics, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kweishian, Taoyuan, Taiwan.
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