Infected total hip arthroplasty revision: One- or two-stage procedure?

Klouche, Shahnaz; Léonard, Philippe; Zeller, Valérie; Lhotellier, Luc; Graff, Wilfrid; Leclerc, Philippe; Mamoudy, P.; Sariali, Elhadi

doi:10.1016/j.otsr.2011.08.018

Cited by 118 publications

(75 citation statements)

References 18 publications

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“…The final results of the two stage procedure are satisfactory in terms of function, pain and eradication of infection (9.2%). Two-stage reimplantations have previously been found to successfully eradicate infection in 84-100% [1][2][3], which is consistent with our observations. A systematic review and metaanalysis based on aggregate published data found the reinfection rate after one-or two-stage revision to be approximately 8% [2].…”

Section: Discussionsupporting

confidence: 92%

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Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer

Marczak

Synder

Sibiński

et al. 2017

International Orthopaedics (SICOT)

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Purpose The aim of this study was to compare two methods of two-stage surgery for PJI (periprosthetic joint infection) after THA (total hip arthroplasty): one with and one without the use of an antibiotic-loaded cement spacer. Methods This retrospective study was performed on 99 consecutive patients (99 hips) with a minimum follow-up of 24 months. Patients were divided into two groups: (1) in whom the operation was performed using a spacer, and (2) for whom a spacer was not used. Results For the whole cohort, the results improved between pre-operative and final follow-up. Recurrence of infection was found in nine out of 98 patients (9.2%) and was not significantly different between the two groups. Patients treated with a spacer had better functional improvement in the interim period, but the VAS score was better in the non-spacer group. The improvement in final function was better in the spacer group with regard to HHS, but not according to WOMAC score or VAS at final follow-up. Conclusion The resection arthroplasty should be awarded particular consideration in cases of poor soft tissue quality, bone stock deficiency, when complications related to spacer use are expected or chances of new hip endoprosthesis implantation are low.

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Section: Discussionsupporting

confidence: 92%

“…The treatment goal is to attempt limb salvage, eradicate infection and preserve joint function. The prognosis for resolving infectious processes in hip arthroplasties ranges from 84 to 100% with current surgical techniques [1][2][3]. The two most common surgical procedures are one-and two-stage revisions.…”

Section: Introductionmentioning

confidence: 99%

Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer

Marczak

Synder

Sibiński

et al. 2017

International Orthopaedics (SICOT)

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“…According to previous reports (Table 3), some surgeons routinely perform one-stage revision THAs, with infection control rates in six studies reported to be 77-100 % [1,2,12,22,23,25]. Others, including our study, selected one-stage revision THA depending on patient requirements and showed infection control rates of 76-100 % in the eight studies [13,[15][16][17][18][19]26]. These rates were similar to those reported in studies only performing onestage revision THAs.…”

Section: Discussionsupporting

confidence: 86%

“…First, the study sample size was small, involving only 55 individuals. Obtaining a large series from a single institution is difficult, and there have been only five literature reports involving relatively large patient series (>50 patients) from a single institution [15][16][17][18][19]. We considered an analysis from a single The values show the mean (range)…”

Section: Discussionmentioning

confidence: 99%

Pre-operative scoring system to determine the surgical strategy for periprosthetic hip infection

Iida

Ueda

et al. 2014

International Orthopaedics (SICOT)

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Purpose The aim of this study was to evaluate the results of one-and two-stage revision total hip arthroplasties (THAs) and to determine a rational surgical treatment strategy for periprosthetic hip infections. Methods We constructed a 12-point preoperative scoring system to suggest either one-or two-stage revision THAs, based on a retrospective analysis of 55 operative procedures. Prosthesis survival was analysed using the Kaplan-Meier method, and the validity of the scoring system was evaluated using receiver-operating characteristic curves. Results At the end point of implant removal due to recurrent infection, the ten year survival rates were 94 and 87 % for oneand two-stage revision THAs, respectively. One-stage revision THA was recommended for patients scoring >9 points. The risk of recurrent infection in patients scoring 4 points was 83 %. The sensitivity and specificity of a cut-off value of 4 points, determined by the scoring system, were 83 and 100 %, respectively. Conclusions The novel pre-operative scoring system was useful for the management of periprosthetic hip infections.

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“…The diagnosis and management of these infections are complex (3)(4)(5)(6), with outcome contingent on detection and identification of the causative microorganism(s) (6,7). The gold standard, culture of synovial fluid, periprosthetic tissue, and/or the implant itself, has been associated with a range of sensitivities (8)(9)(10)(11)(12)(13)(14) and has various turnaround times of up to 2 weeks.…”

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confidence: 99%

Evaluation of a Genus- and Group-Specific Rapid PCR Assay Panel on Synovial Fluid for Diagnosis of Prosthetic Knee Infection

et al. 2016

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We evaluated a genus-and group-specific PCR assay panel using 284 prosthetic knee synovial fluid samples collected from patients presenting to our institution with implant failure. Using the Musculoskeletal Infection Society diagnostic criteria, 88 and 196 samples were classified as showing prosthetic joint infection (PJI) and aseptic failure (AF), respectively. Sensitivities of the synovial fluid PCR panel and culture were 55.6% and 76.1% (P < 0.001), respectively, and specificities were 91.8% and 97.4% (P ‫؍‬ 0.016), respectively. Among the 70 subjects who had received antibiotics within the month preceding synovial fluid aspiration (48 of whom had PJI), PCR panel and synovial fluid culture sensitivities were 64.5% and 85.4%, respectively (P < 0.0001). In this group, the PCR panel detected Staphylococcus aureus in two culture-negative PJI cases. Overall, the evaluated molecular diagnostic tool had low sensitivity when applied to synovial fluid.A s a result of the increase in joint arthroplasty placement in the recent past, we are witnessing increasing numbers of prosthetic joint infections, creating an economic burden on our health system (1, 2). The diagnosis and management of these infections are complex (3-6), with outcome contingent on detection and identification of the causative microorganism(s) (6, 7). The gold standard, culture of synovial fluid, periprosthetic tissue, and/or the implant itself, has been associated with a range of sensitivities (8-14) and has various turnaround times of up to 2 weeks.In recent years, several nucleic acid amplification tests (e.g., PCR) have been evaluated in an attempt to improve the microbiologic diagnosis of prosthetic joint infection (PJI). The potential benefits of these assays include improved turnaround time compared to culture and increased microbiological detection, especially in the setting of prior antibiotic administration, when culture sensitivity may be low (15-21). Results to date have been conflicting, likely due to the various methodologies and specimen types evaluated. While PCR has achieved satisfactory results in tests of prosthesis sonication fluid (19, 21), its value is less clear in tests of synovial fluid.To date, most studies that have evaluated PCR of synovial fluid have been based on detection of the 16S rRNA gene (16)(17)(18)(22)(23)(24)(25)(26)(27). The advantage of this approach is the lack of required specific knowledge of the bacterial group in anticipation of testing (22). Among the major drawbacks of 16S rRNA-based assays are a requirement for the extra step of DNA sequencing to characterize the detected organism, challenges in detecting multiple organisms in polymicrobial infections, and the potential for false-positive results because of the ubiquity of bacterial DNA in containers and reagents used for testing. Studies have shown various sensitivities and specificities (16,17); while false-positive results are not infrequent (18), lack of amplification due to a small amount of bacterial DNA in synovial fluid is also common (25,27).Our...

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Infected total hip arthroplasty revision: One- or two-stage procedure?

Abstract: Level III; prospective case control study.

Cited by 118 publications

References 18 publications

Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer

Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer

Pre-operative scoring system to determine the surgical strategy for periprosthetic hip infection

Evaluation of a Genus- and Group-Specific Rapid PCR Assay Panel on Synovial Fluid for Diagnosis of Prosthetic Knee Infection

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