One‐Stage Arthroplasty or Revision for Seronegative Infections in Hip and Knee

Abstract

Objective To assess the safety and effectiveness of one‐stage total joint arthroplasty (TJA) or revision for seronegative infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods This retrospective study included a total of 495 patients who had undergone one‐stage total joint (hip or knee) arthroplasty or revision with a diagnosis of osteoarthritis secondary to sepsis, osteoarthritis or osteonecrosis of the femoral head (ONFH) secondary to internal fixation surgery of the hip joint, and one‐stage revision for prosthesis loosening after THA or TKA from January 2012 to December 2016. Bacterial cultures were taken from all patients (from joint fluid or articular cavity fluid and four to six different parts of soft tissues) during the operation. If the cultures were positive, patients received antibiotic treatment. Microbiology results from surgical samples, clinical evaluations, SF‐12 score (physical component summary [PCS] and mental component summary [MCS]), Harris hip score (HHS) or Hospital for Special Surgery (HSS) score, and patients' satisfaction was recorded at every follow‐up session. Results A total of 24 patients had a positive result for bacterial culture (4.85%). The bacterial culture results showed that there were 19 cases (79.16%) of gram‐positive cocci (Staphylococcus aureus), 4 cases (16.67%) of gram‐negative bacilli, and 1 case (4.17%) of fungi. For at least 24 months (mean 35 months) follow‐up, no reinfection was discovered. The mean HHS or HSS score improved significantly from 36.29 points preoperatively to 84.21 points postoperatively (P < 0.001). The mean PCS score improved from 10.15 preoperatively to 20.34 postoperatively, and the mean MCS from 13.22 preoperatively to 21.76 postoperatively, with significant differences. Most of the patients were satisfied. Conclusion One‐stage arthroplasty or revision with exhaustive debridement, adequate dosage, and duration of sensitive antibiotics is safe and effective for patients who have seronegative infection of hip or knee joints.

Infecção periprotética do joelho – Parte 2: Tratamento

“…22,24,47 Some authors did not find a difference in outcome in single-stage reviews without prior identification of the etiological agent. 14,48,49 There are reports of revisions at a stage performed "inadvertently", when apparently aseptic revisions were actually septic after intraoperative cultures became positive. 19 Fungal infections by S. epidermidis and S. aureus have a worse evolution and higher incidence of failures.…”

“…22,24,47 Alguns autores não encontraram diferença de desfecho nas revisões em estágio único sem a identificação prévia do agente etiológico. 14,48,49 Há relato de revisões em um estágio realizadas "inadvertidamente", quando revisões aparentemente assépticas se mostraram, na verdade, sépticas após culturas intraoperatórias se tornarem positivas. 19 Infecções fúngicas, por Staphylococcus epidermidis e S. aureus têm pior evolução e maior incidência de falhas.…”