One-stage revision arthroplasty for management of periprosthetic hip infection

Background. Periprosthetic infection is a devastating complication that influences the duration of treatment and patients life quality. Debridement, Antibiotics and Implant Retention (DAIR) is considered as least invasive surgery patients with stable implant, except cases of chronical periprosthetic infection. The aim of this study was to evaluate efficiency of surgical debridement and implant retaining in control over infection in group patients with early postoperative and acute hematogenous periprosthetic infections. Materials and Methods.We performed retrospective monocentral cohort study of treatment early postoperative and acute hematogenous periprosthetic infections of hip in 26 patients. The group included cases with stable implants and period between manifestation of infection and DAIR no more than 4 weeks. We have classified infection as early postoperative in 22 patients (84,2%) and as acute hematogenous in 4 cases (15,8%). Results.At mean follow-up 42,8±2,3 mounts five patients underwent removal of implant due to reinfection. We performed successful twostage revision for four of them and had to perform resection arthroplasty in one case. Thus, DAIR protocol was successful in 80,8(%) cases. The mean Harris Hip Score significantly improved compared to preoperative values from 59,2±2,5 to 80,5±1,3 at the last follow-up (p = 0,0002, Z-3,7). Conclusions.The efficiency of DAIR according to our data was 80,8%. These results allow to consider DAIR as a method of treatment of patients with early postoperative and acute hematogenous periprosthetic infections. Exchange of modular components can decrease the reinfection rate.

Section: Enterobacter Cloacae 1 микробные ассоциации выявлены у 11 пациентовunclassified

Efficiency of Surgical Debridement and Implant Retaining in Treatment of Early Postoperative and Acute Hematogenous Periprosthetic Infections of Hip

Tryapichnikov

Triapichnikov²,

Ермаков

et al. 2021

Treating Periprosthetic Joint Infection With Silver-Impregnated Carbon-Coated Spacers: Mid-Term Outcomes

Malyuchenko,

Nikolaev,

Yakovlev

et al. 2023

The aim of the study to evaluate the antibacterial activity and biological compatibility of alloy coatings based on two-dimensionally ordered linear chain carbon (TDOLCC) and medium-term results of treatment of periprosthetic infection with their use. Materials and Methods. Coatings based on TDOLCC were synthesized using alloying additions like nitrogen (TDOLCC+N) and silver (TDOLCC+Ag) on the surfaces of titanium plates and polystyrene plates by the ion-stimulated carbon condensation in a vacuum. The authors examined the superficial bactericidal activity of the coatings and its resistance to mechanical effects. The rate of formation of microbial biofilms by clinical isolates with multiple and extreme resistance to antibiotics was assessed by staining the samples with a solution of crystal violet. The cytotoxic effect of the coatings was evaluated in relation to the primary culture of fibroblasts and keratinocyte cells of the HaCaT line. Results. The authors observed pronounced superficial bactericidal effect of TDOLCC+Ag coating in respect of microorganisms of several taxonomic groups independently of their resistance to antibacterial drugs. TDOLCC+Ag coating proved capable to completely prevent microbial biofilm formation by antibiotic resistant clinical isolates of S. aureus and P. aeruginosa. Silvercontaining coating demonstrated mechanical resistance and preservation of close to baseline level of superficial bactericidal activity even after lengthy abrasion treatment. TDOLCC based coatings did not cause any cytotoxic effects. Structure of monolayers formed in cavities coated by TDOLCC+N and TDOLCC+Ag was indistinguishable from the monolayers in cavities of control plates. Conclusions. The high anti-film activity of DU LCC+Ag coatings was proved in experiment and clinical practice at the follow-up stage. The use of a spacer with a test coating allows you to quickly eliminate the inflammatory process, significantly reduce the number of relapses of PJI in cases of CS and TB infections, and reduce the number of hospital stay days. Evaluation of the mid-term results of PJI treatment gives grounds to predict active protection of the implant surface from colonization by microorganisms and the formation of microbial biofilms, which, together with drug antibiotic prophylaxis, provides a good therapeutic and prophylactic effect on the recurrence of periprosthetic infection.

“Unexpected” Infections in Revision Arthroplasty for Aseptic Loosening

Николаев

Станиславович²,

Pchelova³

et al. 2021

Background. Data from the national registers of arthroplasty showed that about 12% of hip and knee arthroplasty undergo revision within 10 years after the primary surgery. The leading cause of hip revisions is aseptic loosening of components, knee joint periprosthetic infection (PPI). Some of the infectious complications, including those related to mechanical causes, remain out of sight. The aim of the study was to identify the frequency of unexpected infections during revision knee and hip arthroplasty performed for aseptic complications of any etiology. Materials and Methods. 839 cases of revision arthroplasty of knee and hip joints were analyzed, including 485 aseptic revisions in 450 patients. Clinical, X-ray, laboratory (complete blood count and comprehensive metabolic panel, coagulation panel) methods, synovial fluid analysis and microbiological examination of punctures, including intraoperative ones, were used. The ICM and EBJIS (European Bone and Joint Infections Society) consensus recommendations were used as criteria for assessing the presence of infection. Results. The average age of patients at the time of the revision was 61.7 years. The hip joint prevailed (59.4%), knee joint 40.6%. The growth of microorganisms in the intraoperative biomaterial was detected in 2.08% of observations: in 10 out of 287 patients after aseptic revision of the hip joints and in none of the 198 revisions of the knee joints. In 8 out of 10 cases, the causative agents were coagulase-negative staphylococci, including 6 MRSE; in two cases, anaerobic bacteria. All revisions were carried out by a one-stage method. Patients with detected PPI underwent systemic antibacterial therapy. At the stage of catamnesis, reinfection was assumed in one of the 10 identified cases of PPI, the patient did not show up for revision. In control 63% of the group of the other (aseptic) 470 patients, PPI developed in 4 cases, two-stage revisions were carried out. Conclusions. The frequency of infections accidentally detected during aseptic revisions of large joints was 2.08%. Three-time examination of joint punctures, including intraoperative, provides additional opportunities for the diagnosis of PPI during aseptic revision, and also allows you to choose the optimal stage of revision treatment. The experience gained makes it possible in certain cases to perform one-stage revision in the treatment of PPI.