Improving outcomes in acute and chronic periprosthetic hip and knee joint infection with a multidisciplinary approach

Abstract

Aims Periprosthetic hip and knee infection remains one of the most severe complications following arthroplasty, with an incidence between 0.5% to 1%. This study compares the outcomes of revision surgery for periprosthetic joint infection (PJI) following hip and knee arthroplasty prior to and after implementation of a specialist PJI multidisciplinary team (MDT). Methods Data was retrospectively analyzed from a single centre. In all, 29 consecutive joints prior to the implementation of an infection MDT in November 2016 were compared with 29 consecutive joints subsequent to the MDT conception. All individuals who underwent a debridement antibiotics and implant retention (DAIR) procedure, a one-stage revision, or a two-stage revision for an acute or chronic PJI in this time period were included. The definition of successfully treated PJI was based on the Delphi international multidisciplinary consensus. Results There were no statistically significant differences in patient demographics or comorbidities between the groups. There was also no significant difference in length of overall hospital stay (p = 0.530). The time taken for formal microbiology advice was significantly shorter in the post MDT group (p = 0.0001). There was a significant difference in failure rates between the two groups (p = 0.001), with 12 individuals (41.38%) pre-MDT requiring further revision surgery compared with one individual (6.67%) post-MDT inception. Conclusion Our standardized multidisciplinary approach for periprosthetic knee and hip joint infection shows a significant reduction in failure rates following revision surgery. Following implementation of our MDT, our success rate in treating PJI is 96.55%, higher than what current literature suggests. We advocate the role of a specialist infection MDT in the management of patients with a PJI to allow an individualized patient-centred approach and care plan, thereby reducing postoperative complications and failure rates. Cite this article: Bone Jt Open 2021;2(7):509–514.

Development of evidence-based guidelines for the treatment and management of periprosthetic hip infection

“…While surgical strategies have evolved and recent shifts in practice are already aligned with many of these guidelines, 30,31 psychological support is increasingly seen to be crucial for PJI patients and may stand out as the most challenging to address. Evidence from the INFORM programme described the psychological impact on patients and their unmet needs, 4,21,22,32 but more recent studies have also identified this gap in provision and the need for more research in this area.…”

Management of Periprosthetic Joint Infections After Hemiarthroplasty of the Hip

“…Surgeon expertise is also an important factor in the management of infections after hip HA. A multidisci-plinary approach has proven to be beneficial in decreasing hospital stay, reducing the need for multiple revision surgical procedures, decreasing the number of different antibiotics needed, and decreasing failure rates 19,20,78 . As such, surgical intervention should be performed by a surgeon with good fundamental knowledge of both the diagnosis and treatment of PJI.…”

“…Treatment for PJI after hip HA should be centralized at specialty centers with well-established multidisciplinary teams to minimize treatment failure 20,78 . B *According to Wright 114 , grade A indicates good evidence (Level-I studies with consistent findings) for or against recommending intervention; grade B, fair evidence (Level-II or III studies with consistent findings) for or against recommending intervention; grade C, poor-quality evidence (Level-IV or V studies with consistent findings) for or against recommending intervention; and grade I, insufficient or conflicting evidence not allowing a recommendation for or against intervention.…”

Individuelle Megaspacer für den zweizeitigen Wechsel infizierter Hüftendoprothesen – klinisches und funktionelles Outcome nach 2 Jahren

“…Die optimale Strategie zur Antibiotikatherapie bei der zweizeitigen PPI-Sanierung wird diskutiert [ 24 ]. Izakovicova et al.…”