Outcome of short versus long interval in two-stage exchange for periprosthetic joint infection: a prospective cohort study

Winkler, Tobias; Stuhlert, Malte; Lieb, Elke; Müller, Michael; Roth, Philipp von; Preininger, Bernd; Trampuž, Andrej; Perka, Carsten

doi:10.1007/s00402-018-3052-4

Cited by 43 publications

(31 citation statements)

References 26 publications

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“…To date, there is no reliable marker to prove the eradication of infection at the time of reimplantation. In a recent study, the outcome of PJI treatment remained high despite omission of the antibiotic-free interval before re-implantation [78].…”

Section: Errors Using Antibiotic-loaded Cement Spacersmentioning

confidence: 98%

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Renz

Trampuž

et al. 2019

International Orthopaedics (SICOT)

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Background Misconceptions and errors in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The goal of this paper is to systematically describe twenty common mistakes in the diagnosis and management of PJI, to help surgeons avoid these pitfalls. Materials and methods Common diagnostic and treatment errors are described, analyzed and interpreted. Results Diagnostic errors include the use of serum inflammatory biomarkers (such as C-reactive protein) to rule out PJI, incomplete evaluation of joint aspirate, and suboptimal microbiological procedures (such as using swabs or collection of insufficient number of periprosthetic samples). Further errors are missing possible sources of distant infection in hematogenous PJI or overreliance on suboptimal diagnostic criteria which can hinder or delay the diagnosis of PJI or mislabel infections as aseptic failure. Insufficient surgical treatment or inadequate antibiotic treatment are further reasons for treatment failure and emergence of antimicrobial resistance. Finally, wrong surgical indication, both underdebridement and overdebridement or failure to individualize treatment can jeopardize surgical results. Conclusion Multidisciplinary teamwork with infectious disease specialists and microbiologists in collaboration with orthopedic surgeons have a synergistic effect on the management of PJI. An awareness of the possible pitfalls can improve diagnosis and treatment results.

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Section: Errors Using Antibiotic-loaded Cement Spacersmentioning

confidence: 98%

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Renz

Trampuž

et al. 2019

International Orthopaedics (SICOT)

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“…Importantly, patients with a shorter prosthesis-free interval had a lower local complication rate after reimplantation compared with patients treated with prosthesis-free interval >10 weeks, while the complications during the first and second stages showed no difference. Other authors also recommended early reimplantation to avoid soft tissue contracture and leg length discrepancy [27].…”

Section: Discussionmentioning

confidence: 99%

Complications of Resection Arthroplasty in Two-Stage Revision for the Treatment of Periprosthetic Hip Joint Infection

Sigmund

Winkler

Önder

et al. 2019

JCM

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Little data is available regarding complications associated with resection arthroplasty in the treatment of hip periprosthetic joint infection (PJI). We assessed complications during and after two-stage revision using resection arthroplasty. In this retrospective study, 93 patients undergoing resection arthroplasty for hip PJI were included. Patients were assigned to a prosthesis-free interval of ≤10 weeks (group 1; 49 patients) or >10 weeks (group 2; 44 patients). The complication rates between groups were compared using the chi-squared test. The revision-free and infection-free survival was estimated using a Kaplan–Meier survival analysis. Seventy-one patients (76%) experienced at least one local complication (overall 146 complications). Common complications were blood loss during reimplantation (n = 25) or during explantation (n = 23), persistent infection (n = 16), leg length discrepancy (n = 13) and reinfection (n = 9). Patients in group 1 experienced less complications after reimplantation (p = 0.012). With increasing severity of acetabular bone defects, higher incidence of complications (p = 0.008), periprosthetic bone fractures (p = 0.05) and blood loss (p = 0.039) was observed. The infection-free survival rate at 24 months was 93.9% in group 1 and 85.9% in group 2. The indication for resection arthroplasty needs to be evaluated carefully, considering the high rate of complications and reduced mobility, particularly if longer prosthesis-free intervals are used.

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“…Empiric antibiotic treatment was started intravenously after surgery and was subsequently adapted according to the susceptibility of the isolated organism. The intravenous treatment was typically continued for at least 2 weeks, followed by oral antibiotic treatment, as previously described [25, 26]. In case of a two-stage revision, antibiotics were administered without interruption until re-implantation.…”

Section: Methodsmentioning

confidence: 99%

Enterococcal periprosthetic joint infection: clinical and microbiological findings from an 8-year retrospective cohort study

et al. 2019

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BackgroundTreatment of enterococcal periprosthetic joint infections (PJI) is challenging due to non-standardized management strategies and lack of biofilm-active antibiotics. The optimal surgical and antimicrobial therapy are unknown. Therefore, we evaluated characteristics and outcome of enterococcal PJI.MethodsConsecutive patients with enterococcal PJI from two specialized orthopedic institutions were retrospectively analyzed. Both institutions are following the same diagnostic and treatment concepts. The probability of relapse-free survival was estimated using Kaplan-Meier survival curves and compared by log-rank test. Treatment success was defined by absence of relapse or persistence of PJI due to enterococci or death related to enterococcal PJI. Clinical success was defined by the infection-free status, no subsequent surgical intervention for persistent or perioperative infection after re-implantation and no PJI-related death within 3 months.ResultsIncluded were 75 enterococcal PJI episodes, involving 41 hip, 30 knee, 2 elbow and 2 shoulder prostheses. PJI occurred postoperatively in 61 episodes (81%), hematogenously in 13 (17%) and by contiguous spread in one. E. faecalis grew in 64 episodes, E. faecium in 10 and E. casseliflavus in one episode(s). Additional microorganism(s) were isolated in 38 patients (51%). Enterococci were susceptible to vancomycin in 73 of 75 isolates (97%), to daptomycin in all 75 isolates, and to fosfomycin in 21 of 22 isolates (96%). The outcome data was available for 66 patients (88%). The treatment success after 3 years was 83.7% (95% confidence interval [CI]; 76.1–96.7%) and the clinical success was 67.5% (95% CI; 57.3–80.8%). In 11 patients (17%), a new PJI episode caused by a different pathogen occurred. All failures occurred within 3 years after surgery.ConclusionAbout half of enterococcal PJI were polymicrobial infections. The treatment success was high (84%). All treatment failures occurred within the first 3 years after revision surgery. Interestingly, 17% of patients experienced a new PJI caused by another pathogen at a later stage.Trial registrationThe study was retrospectively registered with the public clinical trial identification NCT0253022 at https://www.clinicaltrials.gov on 15 July 2015.

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Outcome of short versus long interval in two-stage exchange for periprosthetic joint infection: a prospective cohort study

Cited by 43 publications

References 26 publications

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Complications of Resection Arthroplasty in Two-Stage Revision for the Treatment of Periprosthetic Hip Joint Infection

Enterococcal periprosthetic joint infection: clinical and microbiological findings from an 8-year retrospective cohort study

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