Risk Factors and Treatment Options for Failure of a Two-Stage Exchange

Fagotti, Lorenzo; Tatka, Jakub; Salles, Mauro José Costa; Queiroz, Marcelo Cavalheiro de

doi:10.1007/s12178-018-9504-1

Cited by 45 publications

(43 citation statements)

References 62 publications

(82 reference statements)

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“…In spite of increased interest and advances in the diagnosis and management of PJI [3][4][5][6][7], it remains a challenge for the treating physicians, and recent meta-analyses have reported microbiological failure rates of 0-40% for one-and two-stage revision for infected hip and knee arthroplasties [8][9][10][11][12]. Failure can be due to patient factors, microbiological factors [13], or factors related to errors during diagnosis and treatment [14,15]. The goal of this article is to provide a summary of the possible pitfalls and errors during the process of diagnosing and treating PJI.…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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

Renz

Trampuž

et al. 2019

International Orthopaedics (SICOT)

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“…Gram negative and polymicrobial infections have been identified as factors of worse outcome. These pathogens are especially challenging in septic revisions due to the small number of effective antibiotics, the high frequency of Multidrug Resistance (MDR), Gram-negative bacilli especially in southern European regions and low drug bioavailability within the bony tissue [28,29].…”

Section: Plos Onementioning

confidence: 99%

Conservative two-stage revision with primary components of infected total hip arthroplasty: An analysis of survival, clinical and radiographic outcomes

et al. 2020

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Few studies provide an analysis of conservative two-stage revision of hip periprosthetic joint infection (PJI) and its impact on final outcome. A conservative revision is defined when soft tissues and bone quality enable the use of primary prosthetic components. Data of patients treated for chronic hip PJI who underwent two-stage revision between 2009 and 2016 and had a minimum of 2 years of follow-up were collected. Oxford Hip Score (OHS), Harris Hip Score (HHS) and radiological and microbiological data were retrieved and analysed. Clinical and functional outcome, survival, mortality, eradication, reinfection and re-revision rates within subgroups of patients with primary components and revision components are reported herein. A total of 148 patients underwent two-stage hip exchange with a mean follow-up of 55.6 ± 23.1 months and a mean age at surgery of 64.3 ± 12.7 years. Forty-four percent of patients underwent conservative revision. The mean HHS significantly improved from 40.6 ± 9.4 points to the final value of 87.8 ± 10.5 points (p = .002), and the mean OHS went from 20.3 ± 3.8 points to 40.3 ± 5. points (p< .001). Patients who were treated with primary components or isolated revision stems in the second stage had a significant reduction in surgical times (p< .001). The mortality rate for all causes of death was 6.8%, the eradication rate was 89.9%, the reinfection rate was 4.7% and the reoperation rate was 7.4% without differences between conservative and non-conservative revisions. Two-stage exchange arthroplasty for total hip arthroplasty (THA) PJI is a good strategy that provides satisfactory results, high eradication rates and no further need for revision. The conservative two-stage revision in patients with adequate bone stock represents a feasible option with good results and survival rates.

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“…Despite excellent success with two-stage revision arthroplasty for the eradication of infection [3], on occasion, salvage procedures must be utilized. Fagotti et al have highlighted the risk factors which can lead to failure of a two-stage revision TKR [11]. The patient had several of these poor prognosticators and would not have been suitable for revision TKR.…”

Section: Discussionmentioning

confidence: 99%

Two-Stage Arthrodesis after an Infected Total Knee Replacement Using a Coupled Nail and Dual-Plate Construct: A Third-World Solution and Review of Options

Mencia

Goalan

Bua

2020

Case Reports in Orthopedics

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Infection following total knee arthroplasty is a serious and increasingly common complication. Several treatment options are available. Although a two-stage revision remains the gold standard, salvage procedures are sometimes needed. We describe a case of an infected knee arthroplasty that was salvaged using a novel technique combining two linked intramedullary nails and bilateral compression plating.

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Risk Factors and Treatment Options for Failure of a Two-Stage Exchange

Cited by 45 publications

References 62 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

Conservative two-stage revision with primary components of infected total hip arthroplasty: An analysis of survival, clinical and radiographic outcomes

Two-Stage Arthrodesis after an Infected Total Knee Replacement Using a Coupled Nail and Dual-Plate Construct: A Third-World Solution and Review of Options

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