Single-stage treatment of chronically infected total hip arthroplasty with cementless reconstruction

Ji, Baochao; Wahafu, Tuerhongjiang; Li, G; Zhang, X; Wang, Y; Momin, M; Cao, Li

doi:10.1302/0301-620x.101b4.bjj-2018-1109.r1

Cited by 28 publications

(18 citation statements)

References 41 publications

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“…The trend for single-stage revision surgery for PJI appears to be increasing due to the inherent advantages mentioned earlier; however, it is extremely difficult to interpret data as this procedure tends to be performed in healthier patients with better bone stock and less-virulent organisms. Eradication rates and functional scores are thus inherently high if not better than those reported for 2stage exchange [33,48,52,56]. Furthermore, mortality at 10 years has been reported at 30.3% [52] compared to 15% at a mean 8.6-year follow-up [64] and 48% at a mean 15-year follow-up [8] in patients treated with 2-stage protocol.…”

Section: Single-stage Exchange Arthroplastymentioning

confidence: 93%

Single vs 2-Stage Revision for the Treatment of Periprosthetic Joint Infection

Kildow

DellaValle

Springer

2020

The Journal of Arthroplasty

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Section: Single-stage Exchange Arthroplastymentioning

confidence: 93%

Single vs 2-Stage Revision for the Treatment of Periprosthetic Joint Infection

Kildow

DellaValle

Springer

2020

The Journal of Arthroplasty

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“…32 Our infection recurrence rate of 7.9% in patients surviving beyond two years is comparable with reported literature of single-stage revisions. [21][22][23]33 In cementless one-stage revision, Lange et al 23 found a 91.1% infection-free survival in 53 patients at a mean follow-up of 35.1 months, and Ji et al 34 similarly found a success rate of 89.2% in 126 patients, at a mean follow-up of 58 months. In acute postoperative infection, Hansen et al 22 found an implant retention rate of 70% at a mean follow-up of 50 months.…”

Section: Discussionmentioning

confidence: 99%

Cement-in-cement revision of the femur in infected hip arthroplasty in 89 patients across two centres

Fishley

Selvaratnam

Whitehouse

et al. 2022

The Bone & Joint Journal

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Aims Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision of hip arthroplasty necessitate removal of all bone cement from the femur. In our two centres, we have been using a cement-in-cement technique, leaving the distal femoral bone cement in selected patients for septic hip revision surgery, both for single and the first of two-stage revision procedures. A prerequisite for adoption of this technique is that the surgeon considers the cement mantle to be intimately fixed to bone without an intervening membrane between cement and host bone. We aim to report our experience for this technique. Methods We have analyzed patients undergoing this cement-in-cement technique for femoral revision in infection, and present a consecutive series of 89 patients. Follow-up was undertaken at a mean of 56.5 months (24.0 to 134.7) for the surviving cases. Results Seven patients (7.9%) required further revision for infection. Ten patients died of causes unrelated to their infection before their two-year review (mean 5.9 months; 0.9 to 18.6). One patient was lost to follow-up at five months after surgery, and two patients died of causes unrelated to their hip shortly after their two-year review was due without attending. Of the remaining patients, 69 remained infection-free at final review. Radiological review confirms the mechanical success of the procedure as previously described in aseptic revision, and postoperative Oxford Hip Scores suggest satisfactory functional outcomes. Conclusion In conclusion, we found that retaining a well-fixed femoral cement mantle in the presence of infection and undertaking a cement-in-cement revision was successful in 82 of the patients (92.1%) in our series of 89, both in terms of eradication of infection and component fixation. These results are comparable to other more invasive techniques and offer significant potential benefits to the patient. Cite this article: Bone Joint J 2022;104-B(2):212–220.

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“…Fungal infection, culture-negative PJI, and multidrug-resistant bacteria all form our inclusion criteria for single-stage revision. 16 The criteria for intra-articular antibiotic infusion after single-stage revision were PJIs with previous multiple failed operative interventions, fungal infections, culture-negative PJIs, multidrug-resistant bacteria, or polymicrobial infections.…”

Section: Methodsmentioning

confidence: 99%

Effective single-stage revision using intra-articular antibiotic infusion after multiple failed surgery for periprosthetic joint infection

Zhang

et al. 2022

The Bone & Joint Journal

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Aims Periprosthetic joint infections (PJIs) with prior multiple failed surgery for reinfection represent a huge challenge for surgeons because of poor vascular supply and biofilm formation. This study aims to determine the results of single-stage revision using intra-articular antibiotic infusion in treating this condition. Methods A retrospective analysis included 78 PJI patients (29 hips; 49 knees) who had undergone multiple prior surgical interventions. Our cohort was treated with single-stage revision using a supplementary intra-articular antibiotic infusion. Of these 78 patients, 59 had undergone more than two prior failed debridement and implant retentions, 12 patients had a failed arthroplasty resection, three hips had previously undergone failed two-stage revision, and four had a failed one-stage revision before their single-stage revision. Previous failure was defined as infection recurrence requiring surgical intervention. Besides intravenous pathogen-sensitive agents, an intra-articular infusion of vancomycin, imipenem, or voriconazole was performed postoperatively. The antibiotic solution was soaked into the joint for 24 hours for a mean of 16 days (12 to 21), then extracted before next injection. Recurrence of infection and clinical outcomes were evaluated. Results A total of 68 patients (87.1%) were free of infection at a mean follow-up time of 85 months (24 to 133). The seven-year infection-free survival was 87.6% (95% confidence interval (CI) 79.4 to 95.8). No significant difference in infection-free survival was observed between hip and knee PJIs (91.5% (95% CI 79.9 to 100) vs 84.7% (95% CI 73.1 to 96.3); p = 0.648). The mean postoperative Harris Hip Score was 76.1 points (63.2 to 92.4) and Hospital for Special Surgery score was 78. 2 (63.2 to 92.4) at the most recent assessment. Polymicrobial and fungal infections accounted for 14.1% (11/78) and 9.0% (7/78) of all cases, respectively. Conclusion Single-stage revision with intra-articular antibiotic infusion can provide high antibiotic concentration in synovial fluid, thereby overcoming reduced vascular supply and biofilm formation. This supplementary route of administration may be a viable option in treating PJI after multiple failed prior surgeries for reinfection. Cite this article: Bone Joint J 2022;104-B(7):867–874.

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Single-stage treatment of chronically infected total hip arthroplasty with cementless reconstruction

Cited by 28 publications

References 41 publications

Single vs 2-Stage Revision for the Treatment of Periprosthetic Joint Infection

Single vs 2-Stage Revision for the Treatment of Periprosthetic Joint Infection

Cement-in-cement revision of the femur in infected hip arthroplasty in 89 patients across two centres

Effective single-stage revision using intra-articular antibiotic infusion after multiple failed surgery for periprosthetic joint infection

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