Six-week antibiotic therapy after one-stage replacement arthroplasty for hip and knee periprosthetic joint infection

Chieffo, G; Corsia, Simon; Rougereau, Grégoire; Enser, Maya; Eyrolle, L.; Kernéis, Solen; Morand, P; Gauzit, R.; Leclerc, Philippe; Wipff, P; Allanore, Yannick; Anract, Philippe; Salmon, Dominique

doi:10.1016/j.medmal.2020.03.003

Cited by 9 publications

(7 citation statements)

References 37 publications

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“…In order to reach the nal diagnosis, all the steps required by the literature (7) have been performed: from the pre-operative anamnestic and laboratory evaluation, to the arthrocentesis up to the two-step revision and antibiotic therapy for 6 weeks, adapted according to antibiogram. (4) Treatment depends on the stage of infection and is based on the classi cation system published by Coventry in 1975 with the modi cation of Tsukayama (2) : Stage I infections occurring acutely within six weeks of implantation; Stage II infections being delayed chronic presentations; Stage III infections occurring in a previously well-functioning joint replacement; Stage IV being unexpected positive culture results in what was thought to be an aseptic revision.…”

Section: Discussionmentioning

confidence: 99%

Infected hip prosthesis in patient with suspected Covid-19 infection

Cosentino¹,

Odorizzi²,

Berger³

2020

Preprint

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Background: Infections following arthroplasty are one of the major risks during this type of surgery.Case presentation: Four and half years after right hip arthroplasty surgery, the patient came back to our attention with pain at the same hip. The instrumental examinations showed signs of cup detachment and therefore, after carefully analyzing the case, we decided to perform a sterile aspiration of the hip in the operating room under C-arm fluoroscopy. Microbiological examinations showed positivity for E.Coli. The patient underwent to surgery to remove the prosthesis and implant a spacer. A therapy with Cefotaxim 2g 1-1-1 for 6 weeks was then set, after which a total arthroplasty was implanted. During this period, the Covid-19 pandemic occurred and therefore the patient performed two nasal-throat swabs, both negative. However, one week after the final surgery, respiratory conditions worsened and we performed a chest X-ray and CT scan, with suggestive images of ground-glass opacification patterns (GGO). Due to the clinic and the characteristic images of the instrumental examinations, the patient was transferred to the observation ward, waiting for the response of two additional swabs, also negative. The patient was then transferred to the ward for patients with typical symptoms of Covid-19 but with negative swabs for two weeks and subsequently discharged at home.Conclusion: Despite the concomitant Covid-19 pandemic, the guidelines in case of periprosthetic hip infection further confirm the correct management of the patient.

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Section: Discussionmentioning

confidence: 99%

Infected hip prosthesis in patient with suspected Covid-19 infection

Cosentino¹,

Odorizzi²,

Berger³

2020

Preprint

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“…Retrospective studies suggest that a maximum duration of 6 weeks is not inferior to longer durations [ 1 – 5 , 13 , 14 ]; even if the infected material is kept in place [ 1 , 3 , 13 , 14 ]. Prospective-randomized trials (RCT) reveal the same results, only the shorter antibiotic arm is arbitrarily fixed to 6 weeks.…”

Section: Background and Rationalementioning

confidence: 99%

Study protocol: short against long antibiotic therapy for infected orthopedic sites — the randomized-controlled SALATIO trials

Uçkay

Wirth

Zörner

et al. 2023

Trials

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Background Few studies address the appropriate duration of post-surgical antibiotic therapy for orthopedic infections; with or without infected residual implants. We perform two similar randomized-clinical trials (RCT) to reduce the antibiotic use and associated adverse events. Methods Two unblinded RCTs in adult patients (non-inferiority with a margin of 10%, a power of 80%) with the primary outcomes “remission” and “microbiologically-identical recurrences” after a combined surgical and antibiotic therapy. The main secondary outcome is antibiotic-related adverse events. The RCTs allocate the participants between 3 vs. 6 weeks of post-surgical systemic antibiotic therapy for implant-free infections and between 6 vs. 12 weeks for residual implant-related infections. We need a total of 280 episodes (randomization schemes 1:1) with a minimal follow-up of 12 months. We perform two interim analyses starting approximately after 1 and 2 years. The study approximatively lasts 3 years. Discussion Both parallel RCTs will enable to prescribe less antibiotics for future orthopedic infections in adult patients. Trial registration ClinicalTrial.gov NCT05499481. Registered on 12 August 2022. Protocol version: 2 (19 May 2022)

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“…Under these circumstances, perhaps the therapy for this special group of patients should be reconsidered. In this context, Chieffo et al [8] recently reported on a postoperative antibiotic course of 6 weeks in patients undergoing one-stage exchange of THA and TKA, gaining an overall remission rate of 90% (44 of 49). In this study, patients were given intravenous antibiotics for a median of 11 days and then switched to a further oral treatment afterwards.…”

Section: Survivorshipmentioning

confidence: 99%

What Is the Mid-term Survivorship of Infected Rotating-hinge Implants Treated with One-stage-exchange?

Ohlmeier

Alrustom

Citak

et al. 2021

Clin Orthop Relat Res

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Background Despite the growing number of studies reporting on periprosthetic joint infection (PJI), there is little information on one-stage exchange arthroplasty for the revision of infected rotating-hinge prostheses, which can be among the most difficult PJI presentations to treat. Questions/purposes After one-stage direct exchange revision for an infected rotating-hinge TKA prosthesis, and using a multimodal approach for infection control, we asked: (1) What is the survivorship free from repeat revision for infection and survivorship free from reoperation for any cause? (2) What is the clinical outcome, based on the Oxford Knee Score, of these patients at the latest follow-up? Methods Between January 2011 and December 2017, we treated 101 patients with infected rotating-hinge knee prostheses at our hospital. All patients who underwent a one-stage exchange using another rotating-hinge implant were potentially eligible for this retrospective study. During that period, we generally used a one-stage approach when treating PJIs. Eighty-three percent (84 of 101) of patients were treated with one-stage exchange, and the remainder were treated with two-stage exchange. Of the 84 treated with one-stage exchange, eight patients died of unrelated causes and were therefore excluded, one patient declined to participate in the study, and another eight patients were lost before the minimum study follow-up of 2 years or had incomplete datasets, leaving 80% (67 of 84) for analysis in this study. The included study population consisted of 60% males (40 of 67) with a mean age of 64 ± 8 years and a mean (range) BMI of 30 ± 6 kg/m2 (21 to 40). The mean number of prior surgeries was 4 ± 2 (1 to 9) on the affected knee. Fifteen percent (10 of 67) of knees had a preoperative joint communicating sinus tract, and 66% (44 of 67) had experienced a prior PJI on the affected knee. The antimicrobial regimen was chosen based on the advice of our infectious disease consultant and individually adapted for the organism cultured. The mean follow-up duration was 6 ± 2 years. Kaplan-Meier survivorship analysis was performed using the endpoints of survivorship free from repeat revision for infection and survivorship free from all-cause revision. The functional outcome was assessed using the Oxford Knee Score (on a 12- to 60-point scale, with lower scores representing less pain and greater function), obtained by interviewing patients for this study at their most recent follow-up visit. Preoperative scores were not obtained. Results The Kaplan-Meier analysis demonstrated an overall survivorship free from reoperation for any cause of 75% (95% CI 64% to 87%) at the mean follow-up of 6 years postoperatively. Survivorship free from any repeat operative procedure for infection was 90% (95% CI 83% to 97%) at 6 years. The mean postoperative Oxford Knee Score was 37 ± 11 points. Conclusion With an overall revision rate of about 25% at 6 years and the limited functional results based on the poor Oxford Knee Scores, patients should be counseled to have modest expectations concerning postoperative pain and function level after one-stage exchange of an infected rotating-hinge arthroplasty. Nevertheless, patients may be informed about a reasonable chance of PJI eradication and might opt for this approach as a means to try to avoid high transfemoral amputation or joint arthrodesis, which in this population often is associated with the inability to ambulate at all. Regarding the relatively high number of patients with aseptic loosening, future studies might focus on implant design of revision knee systems as well. A longer course of oral antibiotics after such procedures may also be warranted to limit the chance of reinfection but requires further study. Level of Evidence Level IV, therapeutic study.

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Six-week antibiotic therapy after one-stage replacement arthroplasty for hip and knee periprosthetic joint infection

Cited by 9 publications

References 37 publications

Infected hip prosthesis in patient with suspected Covid-19 infection

Infected hip prosthesis in patient with suspected Covid-19 infection

Study protocol: short against long antibiotic therapy for infected orthopedic sites — the randomized-controlled SALATIO trials

What Is the Mid-term Survivorship of Infected Rotating-hinge Implants Treated with One-stage-exchange?

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