Long-Term Outcomes of Staged Revision Surgery for Chronic Periprosthetic Joint Infection of Total Hip Arthroplasty

Abstract

Periprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty. Staged revision surgery is considered effective in eradicating PJI. We aimed to determine the rate of infection resolution after each stage of staged revision surgery (first stage, repeat first stage, second stage, excision arthroplasty, and reimplantation) and to assess functional outcomes and the mortality rate at ten years in a consecutive series of 30 chronic PJI of total hip arthroplasties. Infection resolution was defined as no clinical nor laboratory evidence of infection at 24 months after the last surgery and after a minimum of 12 months following cessation of antimicrobial treatment. Four patients died within 24 months of their final surgery. Nineteen patients, 73% (worst-case analysis (wca) 63%), were infection free after 1 surgery; 22 patients, 85% (wca 73%), were infection free after 2 surgeries; and 26 patients, 100% (wca 87%), were infection free after three and four surgeries. The median Harris Hip Score was 41 prior to first revision surgery and improved to 74 at twelve months and 76 at ten years after the final surgery. Thirteen patients died at a mean of 64 months from first revision, giving a mortality rate of 43% at ten years, which is approximately 25% higher than that of an age-matched general population. The results show that with repeated aggressive surgical treatment, most PJIs of the hip are curable. Ten years after successful treatment of PJI, functional outcomes and pain are improved and maintained compared to before initial surgery, but this must be balanced against the high 10-year mortality. Level of evidence: cohort studies.

Incidence and Clinical Risk Factors of Post-Operative Complications following Primary Total Hip Arthroplasty: A 10-Year Population-Based Cohort Study

“…Our data show that these cohorts are sequelae of mechanical complications or thromboembolism. Population-based studies with early outcome data for THA were limited because most studies were completed at a single institution with a limited number of patients [ 39 ]. The current literature demonstrates trends to incorporate THA in fracture management, in addition to the classic indication for inflammatory OA.…”

The Ratio of IL-6 to IL-4 in Synovial Fluid of Knee or Hip Performances a Noteworthy Diagnostic Value in Prosthetic Joint Infection

“…Periprosthetic joint infection (PJI) is one of the most serious complications after artificial joint arthroplasty [ 1 ]. The severity of PJI is mainly manifested by high incidence, mortality and high medical expenses [ 27 ], which imposes a huge medical and economic burden on society and public health [ 28 ]. Because PJI is usually caused by low-virulence microorganisms, it may develop symptoms similar to aseptic failure and different from those typical for acute infection.…”

“…Because PJI is usually caused by low-virulence microorganisms, it may develop symptoms similar to aseptic failure and different from those typical for acute infection. Therefore, there is a considerable lag in clinical diagnosis of PJI [ 28 , 29 ]. In particular, when PJI presents as a chronic capsular infection, the patient may experience a mild systemic response with normal serum laboratory markers.…”

Vastus Lateralis Muscle Flap for High-Risk Patients Undergoing Orthopaedic Hip Surgery

“…The multistaged modification consists of a single-stage correction in addition to resection arthroplasty or antibiotic-coated implantation on the prosthesis. 1 Management of PJI continues to be controversial, 4 with failure rates ranging from 11% to 35%. 5 Unfortunately, outcomes have not shown improvement over time, 6 with poor quality of life and long-term joint function.…”

“…The primary indication for revision after THA is periprosthetic joint infection (PJI). 1 PJI is commonly treated with surgical debridement, antibiotics, implant retention, and single-stage or multistage revisions. 2,3 A single-stage revision includes implant removal and debridement.…”