Infectiological, functional, and radiographic outcome after revision for prosthetic hip infection according to a strict algorithm

Man, F. H. R. De; Sendi, Parham; Zimmerli, Werner; Maurer, Tobias; Ochsner, P. E.; Ilchmann, Thomas

doi:10.3109/17453674.2010.548025

Cited by 88 publications

(70 citation statements)

References 42 publications

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“…This is the reason why Zimmerli et al [3,7] suggest different therapy strategies with respect to the underlying causative organism, especially when not sensitive to rifampicin. This was the case in about 5 % of our patients who underwent a one-stage revision with only monobacterial infections by gram-positive pathogens that were not multiresistant as in many other study groups [6,21].…”

Section: Discussionmentioning

confidence: 93%

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Periprosthetic joint infection—effect on quality of life

Helwig

Morlock

Oberst

et al. 2014

International Orthopaedics (SICOT)

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Purpose Relatively little is known about the extent to which periprosthetic joint infections (PJI) affect the patient's longterm quality of life (QoL). Our study aim was to assess the effect of a periprosthetic infection on our patients' QoL. Methods We collected data retrospectively of patients who had undergone surgery in our institution between 2006 and 2011. To capture their overall QoL, we telephoned the patients who could be reached and asked them the questions on the SF-12 questionnaire. Results In 84 patients (53 male, 31 female, 43 TKA and 41 THA), 88 % of the hip infections and 62 % of the knee infections had been successfully treated. The hip infections' cure rate was significantly higher than that of the knee joint infections.The average SF-12 score was 36.2 points on the physical scale and 52 on the mental scale. The difference in QoL between patients with and without successful infection therapy was not significant, nor did the site of the infection (knee or hip) influence QoL significantly.Comparison of our patients' QoL data to that from the general population revealed a significant difference in the physical scale but not the mental scale. Conclusion From these results QoL is substantially reduced after a prosthetic infection. We did however observe that postGirdelstone procedure patients or those with an arthrodesis attained an acceptable QoL, and that those methods remain therapeutic alternatives as far as patient-perceived QoL is concerned.

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Section: Discussionmentioning

confidence: 93%

“…Recent studies have demonstrated that a one-stage revision can resolve infections in certain patients at a similar rate of success while obtaining better clinical outcomes [6,7]. However, little is known about how a prosthetic infection affects a patient's long-term quality of life (QoL).…”

Section: Introductionmentioning

confidence: 99%

Periprosthetic joint infection—effect on quality of life

Helwig

Morlock

Oberst

et al. 2014

International Orthopaedics (SICOT)

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“…The recent IDSA (Infectious Diseases Society of America) guidelines advise individual judgment in all cases, but endorse the use of treatment algorithms when DAIR has failed, since it has been proven that their use increases treatment success [2] . Unfortunately, the current algorithms do not offer help after the initial treatment choice [1,2,88,89] . If the symptoms remain and the tissue status progressively worsens, it may be possible to move down the algorithm thereby choosing an alternative treatment plan.…”

Section: Risk Factors For Dair Treatment Failurementioning

confidence: 99%

Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts

Kuiper

Willink

Moojen

et al. 2014

WJO

103

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Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing effect on health care costs. Many risk factors have been identified that increase the risk of developing PJI, including obesity, immune system deficiencies, malignancy, previous surgery of the same joint and longer operating time. Acute PJI occurs either postoperatively (4 wk to 3 mo after initial arthroplasty, depending on the classification system), or via hematogenous spreading after a period in which the prosthesis had functioned properly. Diagnosis and the choice of treatment are the cornerstones to success. Although different definitions for PJI have been used in the past, most are more or less similar and include the presence of a sinus tract, blood infection values, synovial white blood cell count, signs of infection on histopathological analysis and one or more positive culture results. Debridement, antibiotics and implant retention (DAIR) is the primary treatment for acute PJI, and should be performed as soon as possible after the development of symptoms. Success rates differ, but most studies report success rates of around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. The use of local antibiotics in addition to the administration of systemic antibiotic agents is also subject to debate, and its pro's and con's should be carefully considered. Systemic treatment, based on culture results, is of importance for all PJI treatments. Additionally, rifampin should be given in Staphylococcal PJIs, unless all foreign material is removed. The most important factors contributing to treatment failure are longer duration of symptoms, a longer time after initial arthroplasty, the need for more debridement procedures, the retention of exchangeable components, and PJI caused by Staphylococcus (aureus or coagulase negative). If DAIR treatment is unsuccessful, the following treatment option should be based on the patient health status and his or her expectations. For the best functional outcome, one-or two-stage revision should be performed after DAIR failure. In conclusion, DAIR is the obvious choice for treatment of acute PJI, with good success rates in selected patients. Key words: Arthroplasty; Prosthesis; Infection; Periprosthetic joint infection; Retention; Debridement antibiotics and implant retention; Debridement; Acute Core tip: Acute periprosthetic joint infection (PJI) is a major complication after total joint arthroplasty, and occurs either postoperatively or via hematogenous spreading. Debridement, antibiotics and implant retention (DAIR), the primary treatment for acute PJI, should be performed as soon as possible after the development of symptoms, and has success rates around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. Sys- REVIEW

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“…De Man et al [2]. These studies allow comparison of data of patients with prosthetic joint infections for individual reinfection risk, taking age, comorbidities, and other factors into consideration.…”

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confidence: 99%

“…Success of single-stage procedures obviously is related to the presence of risk factors. Again, De Man et al [2] and McPherson et al [3] took risk factors into consideration in their treatment or described risk factor-related outcomes of single-stage versus two-stage procedures. A decision for the surgical procedure in terms of PJI should be based on a standardized analysis model of the patient's individual reinfection risk, including the patient's systemic and local factors and the infection type [3].…”

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confidence: 99%