The Fate of Spacers in the Treatment of Periprosthetic Joint Infection

Gómez, Miguel M.; Tan, Timothy L.; Manrique, Jorge; Deirmengian, Gregory K.; Parvızı, Javad

doi:10.2106/jbjs.n.00958

Cited by 180 publications

(117 citation statements)

References 38 publications

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“…Dislocations occurred in 7.5% of patients (6% in group 1, 9% in group 2) within the first four weeks after reconstruction, which is in line with previous reports demonstrating a dislocation rate of 3%-11% in patients treated with resection arthroplasty [22,23,25] and comparable to the dislocation rate with cement spacer, which was described to be 1%-8% [10,22,26]. The probability of periprosthetic fracture after reimplantation in our study was 3.2%, which was similar to the reported incidence of 3.2% with resection arthroplasty and 4.3% with spacer use [22].…”

Section: Discussionsupporting

confidence: 90%

Complications of Resection Arthroplasty in Two-Stage Revision for the Treatment of Periprosthetic Hip Joint Infection

Sigmund

Winkler

Önder

et al. 2019

JCM

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Little data is available regarding complications associated with resection arthroplasty in the treatment of hip periprosthetic joint infection (PJI). We assessed complications during and after two-stage revision using resection arthroplasty. In this retrospective study, 93 patients undergoing resection arthroplasty for hip PJI were included. Patients were assigned to a prosthesis-free interval of ≤10 weeks (group 1; 49 patients) or >10 weeks (group 2; 44 patients). The complication rates between groups were compared using the chi-squared test. The revision-free and infection-free survival was estimated using a Kaplan–Meier survival analysis. Seventy-one patients (76%) experienced at least one local complication (overall 146 complications). Common complications were blood loss during reimplantation (n = 25) or during explantation (n = 23), persistent infection (n = 16), leg length discrepancy (n = 13) and reinfection (n = 9). Patients in group 1 experienced less complications after reimplantation (p = 0.012). With increasing severity of acetabular bone defects, higher incidence of complications (p = 0.008), periprosthetic bone fractures (p = 0.05) and blood loss (p = 0.039) was observed. The infection-free survival rate at 24 months was 93.9% in group 1 and 85.9% in group 2. The indication for resection arthroplasty needs to be evaluated carefully, considering the high rate of complications and reduced mobility, particularly if longer prosthesis-free intervals are used.

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Section: Discussionsupporting

confidence: 90%

Complications of Resection Arthroplasty in Two-Stage Revision for the Treatment of Periprosthetic Hip Joint Infection

Sigmund

Winkler

Önder

et al. 2019

JCM

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“…Current surgical management consists of 1-or 2-stage exchange of the prosthetic components with antibiotic therapy tailored to isolated organisms. 15,16 Some studies report greater than 90% success with eradication of infection with a similar range of protocols. 15 However, a study by Gomez et al 16 suggested that failure of reimplantation after spacer placement, secondary procedures, and overall morbidity in these patients may be higher than appreciated.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 Some studies report greater than 90% success with eradication of infection with a similar range of protocols. 15 However, a study by Gomez et al 16 suggested that failure of reimplantation after spacer placement, secondary procedures, and overall morbidity in these patients may be higher than appreciated. Providing a vascularized muscle bed to cover the proximal femur and reducing the potential space for fluid collection may improve antibiotic pen-etration into the peritrochanteric region and allow more effective skin healing.…”

Section: Discussionmentioning

confidence: 99%

Gluteus Maximus Advancement Flap Procedure for Reconstruction of Posterior Soft Tissue Deficiency in Revision Total Hip Arthroplasty

Ricciardi¹,

Henderson²,

McLawhorn³

et al. 2017

Orthopedics

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The current study describes the surgical technique and early outcomes of a gluteus maximus advancement flap procedure for the treatment of posterior soft tissue insufficiency among patients with complex revision total hip arthroplasty. This retrospective case series was conducted with a prospective, single-institution arthroplasty registry. Patients who underwent a gluteus maximus advancement flap procedure in the setting of revision total hip arthroplasty between January 2012 and January 2016 were eligible for inclusion (N=7). Primary indications for the gluteus maximus flap procedure included periprosthetic infection with persistent wound breakdown (n=4), persistent symptomatic aseptic pseudotumor in the setting of adverse local tissue reaction after unsuccessful operative debridement (n=2), and abductor insufficiency with recurrent hip instability after unsuccessful placement of a constrained liner (n=1). All patients who underwent a gluteus maximus advancement flap procedure for chronic periprosthetic infection or adverse local tissue reaction had healing of the wound and were infection-free at the last follow-up. In the early postoperative period, 2 patients had recurrent wound infection that required flap elevation. The patients remained infection-free after the subsequent procedure. No patient had repeat instability, and no complications of flap necrosis or nerve palsy occurred. The gluteus maximus advancement flap procedure provides a diverse range of soft tissue coverage options for patients with recalcitrant periprosthetic joint infection, adverse local tissue reaction with pseudotumor, or recurrent instability. [Orthopedics. 2017; 40(3):e495-e500.].

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“…Значительное число пациентов, проходящих первую стадию двухэтапной процедуры, не подвергались последующей реимплантации по ряду причин или требовали дополнительной замены спейсера в промежуточный период. Данные об успехе двухэтапных операций должны включать пациентов, которые никогда не подвергались реимплантации [28].…”

Section: статистический анализunclassified

Two-Stage Treatment of Periprostetic Infection: Mid-Term Results

Павлов

Петрова

Шералиев

2019

Traumatology and Orthopedics of Russia

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Purpose — to evaluate the efficiency of two-stage revision arthroplasty performed according to a standardized protocol by a multidisciplinary surgical team. Materials and Methods. 87 patients with deep periprosthetic hip and knee joint infection (PJI) were included into the prospective study. The patients were admitted to the clinic in the period from January 2012 until December 2014 and underwent two-stage revision procedure. First stage included removal of infected implant and insertion of a cemented spacer, second stage — re-implantation of a prosthesis. Results. Re-implantation of a prosthesis was performed in 89.7% (95% CI 82.8–95.4) of cases. Infection recurrence rate was 13.8% (95% CI 6.9–20.7) and 12.8% (95% CI 6.4–21.8) after the first and the second stage, respectively. Overall efficiency of two-stage procedure was 80,5% (95% CI 71.3–88.5) with a median of 4.7 year follow up. Conclusion. Rate of re-implantation, recurrent infection and newly occurred infection should be taken into consideration for evaluation of treatment efficiency. Application of single criteria for assessment of successful treatment outcomes will allow to compare various studies. Positive microbiological tests during the second stage of procedure are not a risk factor for recurrent infection but can be caused by contamination of specimens.

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The Fate of Spacers in the Treatment of Periprosthetic Joint Infection

Cited by 180 publications

References 38 publications

Complications of Resection Arthroplasty in Two-Stage Revision for the Treatment of Periprosthetic Hip Joint Infection

Complications of Resection Arthroplasty in Two-Stage Revision for the Treatment of Periprosthetic Hip Joint Infection

Gluteus Maximus Advancement Flap Procedure for Reconstruction of Posterior Soft Tissue Deficiency in Revision Total Hip Arthroplasty

Two-Stage Treatment of Periprostetic Infection: Mid-Term Results

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