Two-stage revision for periprosthetic joint infection in cemented total hip arthroplasty: an increased risk for failure?

Abstract

Background The impact of the prior fixation mode on the treatment outcome of chronic periprosthetic joint infection (PJI) of the hip is unclear. Removal of cemented total hip arthroplasty (THA) is particularly challenging and residual cement might be associated with reinfection. This study seeks to compare the results of two-stage revision for PJI in cemented and cementless THA. Methods We reviewed 143 consecutive patients undergoing two-stage revision THA for PJI between 2013 and 2018. Thirty-six patients with a fully cemented (n = 6), hybrid femur (n = 26) or hybrid acetabulum (n = 4) THA (cemented group) were matched 1:2 with a cohort of 72 patients who underwent removal of a cementless THA (cementless group). Groups were matched by sex, age, number of prior surgeries and history of infection treatment. Outcomes included microbiological results, interim re-debridement, reinfection, all-cause revision, and modified Harris hip scores (mHHS). Minimum follow-up was 2 years. Results Compared with PJI in cementless THA, patients undergoing removal of cemented THA had increasingly severe femoral bone loss (p = 0.004). Patients in the cemented group had an increased risk for positive cultures during second-stage reimplantation (22% compared to 8%, p = 0.043), higher rates of reinfection (22% compared to 7%, p = 0.021) and all-cause revision (31% compared to 14%, p = 0.039) compared to patients undergoing two-stage revision of cementless THA. Periprosthetic femoral fractures were more frequent in the group of patients with prior cementation (p = .004). Mean mHHS had been 37.5 in the cemented group and 39.1 in the cementless group, and these scores improved significantly in both groups (p < 0.01). Conclusion This study shows that chronic infection in cemented THA might be associated with increased bone loss, higher rates of reinfection and all-cause revision following two-stage revision. This should be useful to clinicians counselling patients with hip PJI and can guide treatment and estimated outcomes.

Triple Encapsulation and Controlled Release of Vancomycin, Rifampicin and Silver from Poly (Methyl Methacrylate) or Poly (Lactic-Co-Glycolic Acid) Nanofibers

“…However, because resistance to this drug can occur very rapidly, it is usually used in combination with other antibiotics, including vancomycin, in orthopedic settings [ 4 , 6 , 7 ]. This combination is very successful against both Gram-positive and -negative bacteria [ 2 , 6 ]. Aragon et al encapsulated rifampicin in PLGA microspheres for decorating polycaprolactone (biodegradable) nanofibers [ 16 ].…”

“…Revision methods for treating such infections usually involve the surgical removal of the implant, debridement, and the insertion of an antibiotic drug-loaded “spacer” implant made from poly (methyl methacrylate) (PMMA) bone cement for up to six weeks. This temporary implant is then removed, and a repeat operation is performed with variable levels of effectiveness (approximately 85%) [ 2 ].…”

The impact of extended preoperative examination on the treatment tactics choice before the second stage of revision hip arthroplasty

“…Прогрессирующий дефицит костной ткани, а также необходимость продолжительного стационарного лечения и неоднократных оперативных вмешательств способствуют повышению риска фатальных осложнений, снижению качества жизни пациентов, нередко приводя к инвалидизации и летальным исходам [4,5,6]. По данным K.M.…”