Outcomes and Risk Factors Associated With 2-Stage Reimplantation Requiring an Interim Spacer Exchange for Periprosthetic Joint Infection

Klemt, Christian; Smith, Evan J.; Tirumala, Venkatsaiakhil; Bounajem, Georges; Kieboom, Janna van den; Kwon, Young Min

doi:10.1016/j.arth.2020.09.012

Cited by 21 publications

(14 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Regarding the risk factor analysis, our study reports a specific patient comorbidity profile, based on age, clinical risk-stratification systems, and chronic organ failure, which appears to be significantly associated with substantial staged exchange complication and failures. The existing literature supports our conclusion, as spacer exchange is reported to be associated with CCI score, 16 and chronic kidney and liver diseases. 19 Moreover, concerning the occurrence of death within one year, Cancienne et al 19 were able to identify an age above 85 years, liver, cardiac, and pulmonary diseases as risk factors.…”

Section: General Complicationsupporting

confidence: 89%

“…The existing literature supports our conclusion, as spacer exchange is reported to be associated with CCI score, 16 and chronic kidney and liver diseases. 19 Moreover, concerning the occurrence of death within one year, Cancienne et al 19 were able to identify an age above 85 years, liver, cardiac, and pulmonary diseases as risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…The recent literature has brought to light inferior clinical and perioperative outcomes as a result of mechanical complications, as well as a higher risk of reinfection, 15 lower survivorship, and functional outcomes after spacer exchange. 16 Moreover, given the substantial number of patients who never undergo reimplantation, the staged revision does not result to previously reported high rates of cure. 14 , 17 , 18 Brown et al 10 has reported mortality rates similar to prostatectomy or kidney transplant.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Failure analysis of articulating polymethyl methacrylate spacers in two-stage revision total hip arthroplasty

Jaubert¹,

Baron²,

Jacquet

et al. 2022

Bone & Joint Open

View full text Add to dashboard Cite

Aims Two-stage exchange revision total hip arthroplasty (THA) performed in case of periprosthetic joint infection (PJI) has been considered for many years as being the gold standard for the treatment of chronic infection. However, over the past decade, there have been concerns about its safety and its effectiveness. The purposes of our study were to investigate our practice, collecting the overall spacer complications, and then to analyze their risk factors. Methods We retrospectively included 125 patients with chronic hip PJI who underwent a staged THA revision performed between January 2013 and December 2019. All spacer complications were systematically collected, and risk factors were analyzed. Statistical evaluations were performed using the Student's t-test, Mann-Whitney U test, and Fisher's exact test. Results Our staged exchange practice shows poor results, which means a 42% mechanical spacer failure rate, and a 20% recurrent infection rate over the two years average follow-up period. Moreover, we found a high rate of spacer dislocation (23%) and a low rate of spacer fracture (8%) compared to the previous literature. Our findings stress that the majority of spacer complications and failures is reflecting a population with high comorbid burden, highlighted by the American Society of Anesthesiology grade, Charlson Comorbidity Index, and Lee score associations, as well as the cardiac, pulmonary, kidney, or hepatic chronic conditions. Conclusion Our experience of a two-stage hip exchange revision noted important complication rates associated with high failure rates of polymethylmethacrylate spacers. These findings must be interpreted in the light of the patient’s comorbidity profiles, as the elective population for staged exchange has an increasing comorbid burden leading to poor results. In order to provide better results for this specific population, our conclusion suggests that comparative strategy studies are required to improve our therapeutic indication. Cite this article: Bone Jt Open 2022;3(6):485–494.

show abstract

Section: General Complicationsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Failure analysis of articulating polymethyl methacrylate spacers in two-stage revision total hip arthroplasty

Jaubert¹,

Baron²,

Jacquet

et al. 2022

Bone & Joint Open

View full text Add to dashboard Cite

show abstract

“…However, similar limitations were reported in prior retrospective studies on this topic. [34][35][36] In conclusion, this study developed and validated five ML models for the prediction of patient-specific SSI following primary TKA. The study findings show excellent model performance, with the best modeling accuracy of ANNs.…”

Section: Discussionmentioning

confidence: 99%

The Use of Artificial Neural Networks for the Prediction of Surgical Site Infection Following TKA

et al. 2022

Self Cite

View full text Add to dashboard Cite

This is a retrospective study. Surgical site infection (SSI) is associated with adverse postoperative outcomes following total knee arthroplasty (TKA). However, accurately predicting SSI remains a clinical challenge due to the multitude of patient and surgical factors associated with SSI. This study aimed to develop and validate machine learning models for the prediction of SSI following primary TKA. This is a retrospective study for patients who underwent primary TKA. Chart review was performed to identify patients with superficial or deep SSIs, defined in concordance with the criteria of the Musculoskeletal Infection Society. All patients had a minimum follow-up of 2 years (range: 2.1–4.7 years). Five machine learning algorithms were developed to predict this outcome, and model assessment was performed by discrimination, calibration, and decision curve analysis. A total of 10,021 consecutive primary TKA patients was included in this study. At an average follow-up of 2.8 ± 1.1 years, SSIs were reported in 404 (4.0%) TKA patients, including 223 superficial SSIs and 181 deep SSIs. The neural network model achieved the best performance across discrimination (area under the receiver operating characteristic curve = 0.84), calibration, and decision curve analysis. The strongest predictors of the occurrence of SSI following primary TKA, in order, were Charlson comorbidity index, obesity (BMI >30 kg/m2), and smoking. The neural network model presented in this study represents an accurate method to predict patient-specific superficial and deep SSIs following primary TKA, which may be employed to assist in clinical decision-making to optimize outcomes in at-risk patients.

show abstract

“…Particularly, in the presence of large bone defects and abductor deficiency, its use often leads to joint instability with the risk of spacer dislocation, spacer migration, spacer breakage, and femur fracture [18,29e33]. Recently, two-stage exchange arthroplasty with spacer placement has been associated with progressive bone loss and increased complexity of reimplantation [34], and patients requiring an interim spacer revision have shown significantly worse clinical outcomes [21,23,32,35].…”

mentioning

confidence: 99%

Two-Stage Revision Total Hip Arthroplasty Without Spacer Placement: A Viable Option to Manage Infection in Patients With Severe Bone Loss or Abductor Deficiency

Hipfl

Carganico

Leopold

et al. 2021

The Journal of Arthroplasty

View full text Add to dashboard Cite

Background: High rates of spacer-related complications in two-stage exchange total hip arthroplasty (THA) have been reported. Patients with advanced bone defects and abductor deficiency may benefit from a nonspacer two-stage revision. This study reports on the clinical course of a contemporary twostage exchange for periprosthetic hip infection without spacer insertion. Methods: We reviewed 141 infected THAs with extensive bone loss or abductor damage who underwent two-stage exchange without spacer placement. The mean duration from resection arthroplasty to reimplantation was 9 weeks (2-29). Clinical outcomes included interim revision, reinfection, and aseptic revision rates. Restoration of leg-length and offset was assessed radiographically. Modified Harris hip scores were calculated. Mean follow-up was 5 years (3-7). Treatment success was defined using the modified Delphi consensus criteria. Results: Thirty-four patients (24%) had treatment failure, including 13 reinfections, 16 interim redebridements for persistent infection, 2 antibiotic suppressive therapies, and 3 prosthetic joint infection erelated deaths. Aseptic rerevision after reimplantation was necessary in 14 patients (10%). Dislocation accounted for most aseptic complications, with 20 dislocations occurring in 15 patients (11%). Leglength and offset were restored to preoperative measures. Mean modified Harris hip scores significantly improved from 35 points to 67 points. Conclusion: A nonspacer two-stage exchange is a viable option for managing chronically infected THA with severe bone loss or abductor deficiency, showing comparable rates of interim revision and recurrence of infection. Cementless reimplantation demonstrates good midterm survivorship with comparable functional outcomes and leg-length restoration. However, dislocation continues to be a major concern.

show abstract

Outcomes and Risk Factors Associated With 2-Stage Reimplantation Requiring an Interim Spacer Exchange for Periprosthetic Joint Infection

Cited by 21 publications

References 44 publications

Failure analysis of articulating polymethyl methacrylate spacers in two-stage revision total hip arthroplasty

Failure analysis of articulating polymethyl methacrylate spacers in two-stage revision total hip arthroplasty

The Use of Artificial Neural Networks for the Prediction of Surgical Site Infection Following TKA

Two-Stage Revision Total Hip Arthroplasty Without Spacer Placement: A Viable Option to Manage Infection in Patients With Severe Bone Loss or Abductor Deficiency

Contact Info

Product

Resources

About