Predictors of Treatment Failure for Hip and Knee Prosthetic Joint Infections in the Setting of 1- and 2-Stage Exchange Arthroplasty: A Multicenter Retrospective Cohort

Abstract

BackgroundProsthetic hip and knee joint infections (PJIs) are challenging to eradicate despite prosthesis removal and antibiotic therapy. There is a need to understand risk factors for PJI treatment failure in the setting of prosthesis removal.MethodsA retrospective cohort of individuals who underwent prosthesis removal for a PJI at 5 hospitals in Toronto, Canada, from 2010 to 2014 was created. Treatment failure was defined as recurrent PJI, amputation, death, or chronic antibiotic suppression. Potential risk factors for treatment failure were abstracted by chart review and assessed using a Cox proportional hazards model.ResultsA total of 533 individuals with prosthesis removal were followed for a median (interquartile range) of 814 (235–1530) days. A 1-stage exchange was performed in 19% (103/533), whereas a 2-stage procedure was completed in 88% (377/430). Treatment failure occurred in 24.8% (132/533) at 2 years; 53% (56/105) of recurrent PJIs were caused by a different bacterial species. At 4 years, treatment failure occurred in 36% of 1-stage and 32% of 2-stage procedures (P = .06). Characteristics associated with treatment failure included liver disease (adjusted hazard ratio [aHR], 3.12; 95% confidence interval [CI], 2.09–4.66), the presence of a sinus tract (aHR, 1.53; 95% CI, 1.12–2.10), preceding debridement with prosthesis retention (aHR, 1.68; 95% CI, 1.13–2.51), a 1-stage procedure (aHR, 1.72; 95% CI, 1.28–2.32), and infection due to Gram-negative bacilli (aHR, 1.35; 95% CI, 1.04–1.76).ConclusionsFailure of PJI therapy is common, and risk factors are not easily modified. Improvements in treatment paradigms are needed, along with efforts to reduce orthopedic surgical site infections.

A Biodegradable Antifungal-Loaded Sol–Gel Coating for the Prevention and Local Treatment of Yeast Prosthetic-Joint Infections

“…Currently, two-stage exchange arthroplasty is considered the best treatment option, with success rates ranging from 50% to over 90% [ 13 , 14 ]. In a significant percentage of patients, however, final reimplantation cannot be completed due to the poor health of the patient or persistent infection, which increases the risk of therapeutic failure and mortality [ 15 , 16 ].…”

Outcomes and Risk Factors in Prosthetic Joint Infections by multidrug-resistant Gram-negative Bacteria: A Retrospective Cohort Study

“…Uçkay and Bernard [ 32 ] reported similar success rates when treating PJIs caused by GPC or GNB. In contrast, several studies have linked GNB-associated PJI with high failure rates [ 16 ]. In our study, surgical options using DAIR had no impact on treatment outcomes, but XDR-PJI was independently associated with poor outcomes.…”

“…Long-term remission of PJI following treatment was defined as the absence of clinical, laboratory and radiological symptoms of infection at the last medical follow-up (with a minimum follow-up point of one year). Therapeutic failure was defined as infection recurrence at a previously controlled site; requirement for new surgery, a second course of antimicrobial therapy, chronic antibiotic suppression, excision arthroplasty or limb amputation, or death within the follow-up period [ 16 , 17 ].…”

Successful treatment of a prosthetic hip infection due to Enterococcus faecalis with sequential dosing of oritavancin and prosthesis preservation without prosthetic joint surgical manipulation

“…Each of these procedures has its advantages and disadvantages. A multicenter, retrospective cohort study performed by Kandel et al reported a combined treatment failure rate of 24.8 % at two years following OSE or TSP; at four years, the failure rate for OSE was reported as 36 % and 32 % for TSP [ 5 ].…”