A standardized interdisciplinary algorithm for the treatment of prosthetic joint infections

Abstract

AimsIn 2013, we introduced a specialized, centralized, and interdisciplinary team in our institution that applied a standardized diagnostic and treatment algorithm for the management of prosthetic joint infections (PJIs). The hypothesis for this study was that the outcome of treatment would be improved using this approach.Patients and MethodsIn a retrospective analysis with a standard postoperative follow-up, 95 patients with a PJI of the hip and knee who were treated with a two-stage exchange between 2013 and 2017 formed the study group. A historical cohort of 86 patients treated between 2009 and 2011 not according to the standardized protocol served as a control group. The success of treatment was defined according to the Delphi criteria in a two-year follow-up.ResultsPatients in the study group had a significantly higher Charlson Comorbidity Index (3.9 vs 3.1; p = 0.009) and rate of previous revisions for infection (52.6% vs 36%; p = 0.025), and tended to be older (69.0 vs 66.2 years; p = 0.075) with a broader polymicrobial spectrum (47.3% vs 33.7%; p = 0.062). The rate of recurrent infection (3.1% vs 10.4%; p = 0.048) and the mean time interval between the two stages of the procedure (66.6 vs 80.7 days; p < 0.001) were reduced significantly in the study group compared with the control group.ConclusionWe were able to show that the outcome following the treatment of PJIs of the hip and knee is better when managed in a separate department with an interdisciplinary team using a standard algorithm.

Evaluation of The Standard Procedure for the Treatment of Periprosthetic Joint Infections (PJI) in Germany - Results of a Survey within the EndoCert Initiative

“…A disadvantage is the repeated anesthesia and relatively limited mobility in the (spacer) interval. The duration of the implant-free interval is 4 to 8 weeks in 61% of the centers and corresponds to the reports in the literature (25,39,42,43). The advantage of the two-stage revision is the shorter duration of the individual procedures and the possibility of obtaining several delayed tissue samples from different areas of the wound region, resulting in early and better detection of infection and appropriate administration of antibiotics (39).…”

High Rates of Aseptic Loosening After Revision Total Knee Arthroplasty for Periprosthetic Joint Infection

“…Two- or multiple-stage exchange surgery is widely accepted as standard treatment for PJI and was performed as previously described 6 , 18 . Briefly, after removal of the affected prosthesis, thorough debridement, and irrigation, patients received a temporary, antibiotic-loaded cement spacer between stages 19 , 20 .…”

“…All surgeries were performed by high-volume surgeons specializing in the treatment of PJI and revision total knee arthroplasty. Patients received antimicrobial therapy for up to 6 weeks after reimplantation 6 . Antimicrobial agents were chosen on the basis of bacterial susceptibility and the recommendations of Zimmerli et al 21 and in consultation with our microbiologists.…”

“…Adequate treatment of PJI is mandatory to achieve a successful, infection-free outcome 4 , 5 . Commonly, patients undergo 1-, 2-, or multiple-stage revision surgery, depending on individual risk factors and pathogen characteristics 6 . Cemented prostheses are often chosen for reimplantation because of the possibility of additional local antibiotic therapy 7 .…”

“…Cemented prostheses are often chosen for reimplantation because of the possibility of additional local antibiotic therapy 7 . The surgical procedure comprises removal of the prosthesis affected by infection, debridement and irrigation, and, in a second-stage surgery, reimplantation of a new prosthesis into the cleaned bone bed 6 . Long-term survival of the new prosthesis depends on an adequate bone-cement interface with close interdigitating between cement and spongy bone 8 .…”