Is Treatment of Periprosthetic Joint Infection Improving Over Time?

Xu, Chi; Goswami, Karan; Li, William T.; Tan, Timothy L.; Yayac, Michael; Wang, Shenghao; Parvızı, Javad

doi:10.1016/j.arth.2020.01.080

Cited by 50 publications

(39 citation statements)

References 29 publications

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“…The goal of surgery must be the complete removal of all infected tissue and implants to eliminate the biofilm and ensure the efficacy of the postoperative antibiotic therapy [5,24]. In our study, we defined treatment success as freedom from signs or symptoms of infection after the end of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, we defined treatment success as freedom from signs or symptoms of infection after the end of treatment. Recently, treatment success has been proposed by an expert panel as the microbiological and clinical eradication of infection without relapsed infection, freedom from subsequent surgical intervention for the same infection, and freedom from mortality related to the PJI [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment options, although often required, may not be possible or appropriate due to severe comorbidities and a resulting increased perioperative risk. These patients may be best managed conservatively, either by long-term antibiotic suppression, acceptance, or even the creation of a new chronically discharging sinus [5,24].…”

Section: Discussionmentioning

confidence: 99%

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Successful Two-Stage Exchange Arthroplasty for Periprosthetic Infection Following Total Knee Arthroplasty: The Impact of Timing on Eradication of Infection

Vielgut¹,

Schwantzer²,

Leithner³

et al. 2021

Int. J. Med. Sci.

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Background: Periprosthetic joint infection (PJI) represents a serious complication following total knee arthroplasty. In the setting of chronic infections, the two-staged approach has traditionally been the preferred treatment method. The aim of this study was to determine the optimal period of rest between the first and second stage. Furthermore, we analyzed potentially outcome-relevant parameters, such as general and local conditions and the presence of difficult-to-treat or unidentified microorganisms, with regard to their impact on successful treatment of PJI. Patients and Methods: We performed a retrospective analysis of prospectively collected data for all patients treated for PJI at our institution. Seventy-seven patients who had undergone two-stage revision arthroplasty for PJI of the knee were included into the study. Antibiotic-loaded cement spacers were used for all patients. Results: After a median follow-up time of 24.5 months, infection had reoccurred in 14 (18.7%) patients. A prolonged spacer-retention period of more than 83 days was related to a significantly higher proportion of reinfections. Furthermore, significant compromising local conditions of the prosthetic tissue and surrounding skin, as well as repeated spacer-exchanges between first-and second-stage surgery, negatively influenced the outcome. Neither the patients' age nor gender exerted a significant influence on the outcome regarding reinfection rates for patients' age or gender. Conclusions: We observed the best outcome regarding infection control in patients who had undergone second-stage surgery within 12 weeks after first-stage surgery. Nearly 90% of these patients stayed free from infection until the final follow-up. An increased number of performed spacer-exchanges and a bad local extremity grade also had a negative impact on the outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Successful Two-Stage Exchange Arthroplasty for Periprosthetic Infection Following Total Knee Arthroplasty: The Impact of Timing on Eradication of Infection

Vielgut¹,

Schwantzer²,

Leithner³

et al. 2021

Int. J. Med. Sci.

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“…There is plenty of literature about the success of DAIR [ 6 ], but less is reported about failed DAIR's fate. Xu et al reported that failed DAIR is not a risk factor for reinfection after two-staged rTKA [ 10 ], and Dzaja et al reported that failed DAIR is not related to worse outcomes after two-stage revision [ 11 ]. On the other hand, there are some reports claiming worse outcomes after failed DAIR [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

The Fate of Failed Debridement, Antibiotics, and Implant Retention in Infected Knee Arthroplasties: Nothing to Lose

Ozturk¹,

Özdemir²,

Turgut³

et al. 2021

Cureus

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Purpose The frequency of periprosthetic knee infections increases yearly because of the popularity of the total knee prostheses. Revision knee arthroplasty is an annoying problem for both the surgeons and the patients. Debridément, antibiotics, and implant retention (DAIR) is a popular alternative for the treatment of periprosthetic knee infections. Little is known about the fate of the failed DAIR patients. This study aims to investigate the effect of the failed DAIR on the clinical result after two-staged revision arthroplasty. Method Ninety-nine two-staged revision arthroplasties and 85 DAIR patients from two reference clinics were retrospectively analyzed. The minimum follow-up was 36 months. Patients were grouped according to the treatment as, two-staged revision without DAIR, two-staged revision after failed DAIR, and successful DAIR. Their Knee Society Scores (KSS), functional KSS (KSS-f) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were analyzed and compared. Results DAIR has a 52.9% success rate for the treatment of infection. Elevated erythrocyte sedimentation rates and C-reactive peptide levels are not risk factors for failure, but the time passed since the index surgery is a risk factor for worse outcome scores. Failed DAIR is not a risk factor for reinfection after two-staged revision. Last KSS after failed DAIR, successful DAIR, and two-staged revision were 83.98±7.033, 91.89±4.386, and 91.38±4.735, respectively. Last KSS-f after failed DAIR, successful DAIR, and two-staged revision were 86.25±9.524, 94.56±8.106, and 94.85±5.996, respectively. Last WOMAC after failed DAIR, successful DAIR, and two-staged revision were 86.16±7.745, 94.750±4.964, and 93.319±5.961, respectively. Conclusion Failed DAIR is associated with lesser, but still good, or excellent clinical scores. DAIR is suggested as a promising treatment option for periprosthetic knee infections in well-selected patients.

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“…A pesar de que se conoce más sobre el manejo de la infección periprotésica (IPP), la tasa de erradicación no ha cambiado en los últimos 20 años. 1 Considerando que la expectativa de vida está en aumento, con un incremento sustancial en la demanda de reemplazos totales de cadera, un incremento concomitante en la incidencia proyectada de IPP significaría un problema epidemiológico grave, dados los costos en salud absorbidos por los pacientes y los sistemas sanitarios. 2 La revisión en dos tiempos, en la cual la extracción y el reimplante de los componentes están separados por un tiempo con un espaciador de cemento con antibióticos, es considerada el patrón de referencia histórico para el tratamiento de la IPP.…”

Section: Introductionunclassified

¿Qué factores hacen fallar un reimplante de cadera luego de una revisión en dos tiempos?

García-Barreiro

Slullitel

Oñativia³

et al. 2021

Rev. Asoc. Arg. Ort. y Traumatol

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Introducción: El objetivo del estudio fue analizar la supervivencia sin recurrencia de infección en pacientes con reemplazo total de cadera tratados con revisión en dos tiempos, valorando el impacto del cultivo intraoperatorio y la congelación positiva en el reimplante. Materiales y Métodos: Estudio retrospectivo de 96 casos con infección periprotésica crónica, según los criterios de la MusculoSkeletal Infection Society, sometidos a los dos tiempos quirúrgicos en nuestra institución, entre 2008 y 2013. El seguimiento promedio fue 90 meses. La falla séptica se definió sobre la base de un consenso tipo Delphi modificado. La supervivencia sin falla séptica se definió sobre la base del estimador de Kaplan-Meier. Se compararon los resultados de supervivencia en función del cultivo intraoperatorio y de los estudios de anatomía patológica por congelación mediante la prueba del orden logarítmico. Resultados: La supervivencia sin falla séptica fue del 82,65% a los 2 años (IC95% 73,25-88,99%), 80,40% a los 5 años (IC95% 70,70-87,17%) y 77,32% a 6-10 años (IC95% 66,90-84,33%). Hubo significativamente más fallas en los pacientes con un cultivo positivo en el reimplante que en aquellos con un cultivo negativo (prueba del orden logarítmico, p = 0,0208), y en quienes tuvieron un estudio anatomopatológico por congelación positivo en el reimplante que en aquellos con un resultado negativo (prueba del orden logarítmico, p = 0,0154). Conclusiones: Los reimplantes sin recurrencias infecciosas por, al menos, 6 años tuvieron un riesgo de falla séptica muy bajo. Cuando se detectó un cultivo o una congelación positivos, la falla séptica fue significativamente mayor.

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Is Treatment of Periprosthetic Joint Infection Improving Over Time?

Cited by 50 publications

References 29 publications

Successful Two-Stage Exchange Arthroplasty for Periprosthetic Infection Following Total Knee Arthroplasty: The Impact of Timing on Eradication of Infection

Successful Two-Stage Exchange Arthroplasty for Periprosthetic Infection Following Total Knee Arthroplasty: The Impact of Timing on Eradication of Infection

The Fate of Failed Debridement, Antibiotics, and Implant Retention in Infected Knee Arthroplasties: Nothing to Lose

¿Qué factores hacen fallar un reimplante de cadera luego de una revisión en dos tiempos?

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