High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange

Abstract

BackgroundTwo-stage exchange arthroplasty is still the preferred treatment choice for chronic PJI. However, the results remain unpredictable. We analyzed the treatment success of patients with an infected hip prosthesis, who were treated according to a standardized algorithm with a multidisciplinary team approach and evaluated with a strict definition of failure.MethodsIn this single-center prospective cohort study, all hip PJI episodes from March 2013 to May 2015 were included. Treatment failure was assessed according to the Delphi-based consensus definition. The Kaplan-Meier survival method was used to estimate the probability of infection-free survival. Patients were dichotomized into two groups depending on the number of previous septic revisions, duration of prosthesis-free interval, positive culture with difficult-to-treat microorganisms, microbiology at explantation, and microbiology at reimplantation.ResultsEighty-four patients with hip PJI were the subject of this study. The most common isolated microorganisms were coagulase-negative staphylococci (CNS) followed by Staphylococcus aureus and Propionibacterium. Almost half of the study cohort (46%) had at least one previous septic revision before admission. The Kaplan-Meier estimated infection-free survival after 3 years was 89.3% (95% CI, 80% to 94%) with 30 patients at risk. The mean follow-up was 33.1 months (range, 24–48 months) with successful treatment of PJI. There were no statistical differences in infect eradication rate among the dichotomized groups.ConclusionsHigh infect eradication rates were achieved in a challenging cohort using a standardized two-stage exchange supported by a multidisciplinary approach.

Biodistribution, biocompatibility and targeted accumulation of magnetic nanoporous silica nanoparticles as drug carrier in orthopedics

“…Implant-associated infections represent one dreaded complication in orthopedics. They occur as a result of contamination during or immediately after surgery or at later periods following hematogenic spread [1][2][3]. Numbers of implantations, in general, are growing because of an aging population, increasing obesity, and other predisposing factors [4][5][6][7].…”

“…In addition, worldwide rising bacterial resistance against antibiotics [8][9][10][11] and further, the irreversible adhesion of bacteria and production of extracellular matrix in biofilm formation on the implant surface (infection cause) complicate a successful treatment [12][13][14]. This challenge is still accomplished by using high systemic doses of antibiotics for several months, accepting adverse side effects [1,15,16]. Apart from intensive costs, this leads to high burdens for the patient as well as risks like amputation of the affected limb or even death in case of treatment failure [5,17].…”

Who Should Manage Periprosthetic Joint Infection? The Case for a Multidisciplinary Approach

“…7 Knowing this, it can be deduced that a similar model may prove to be even more effective for the treatment of the most difficult complication of total joint arthroplasty; PJI. There is evidence in the literature to support this claim as well [11,15]. Ntalos et al studied the effect of establishing a weekly multidisciplinary infection conference consisting of orthopedic surgeon, pathologists, microbiologists, and radiologists and found that it led to significant differences in treatment plans.…”

Two-Stage Treatment of Periprostetic Infection: Mid-Term Results

“…До сих пор существуют различные подходы к лечению ППИ и многие моменты его тактики остаются дискуссионными: оптимальный интервал между операциями, критерии купирования воспаления и необходимость пункции перед реимплантацией, значение положительной культуры на втором этапе, длительность антибактери-альной терапии. Для достижения оптимального результата лечения ППИ необходимы эффективные, своевременные и индивидуальные диагностика и лечение в рамках междисциплинарного сотрудничества [5,6,7,8,9].…”