Two-stage revision for prosthetic joint infection: predictors of outcome and the role of reimplantation microbiology

Abstract

ObjectivesWe describe rates of success for two-stage revision of prosthetic joint infection (PJI), including data on reimplantation microbiology.MethodsWe retrospectively collected data from all the cases of PJI that were managed with two-stage revision over a 4 year period. Patients were managed with an antibiotic-free period before reimplantation, in order to confirm, clinically and microbiologically, that infection was successfully treated.ResultsOne hundred and fifty-two cases were identified. The overall success rate (i.e. retention of the prosthesis over 5.75 years of follow-up) was 83%, but was 89% for first revisions and 73% for re-revisions [hazard ratio = 2.9, 95% confidence interval (CI) 1.2–7.4, P = 0.023]. Reimplantation microbiology was frequently positive (14%), but did not predict outcome (hazard ratio = 1.3, 95% CI 0.4–3.7, P = 0.6). Furthermore, most unplanned debridements following the first stage were carried out before antibiotics were stopped (25 versus 2 debridements).ConclusionsWe did not identify evidence supporting the use of an antibiotic-free period before reimplantation and routine reimplantation microbiology. Re-revision was associated with a significantly worse outcome.

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

“…After pathogen detection, adaption of antibiotic therapy according to the susceptibility profile, individual patient's needs and considering published therapy recommendations [25] was necessary in 31 %. Because of the complexity of PJI such adjustment of antibiotic therapy in an interdisciplinary team based on standardized therapy algorithms seems essential [6,46].…”

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

“…aureus is the most common pathogen in all three major classes of osteoarticular infection, namely, osteomyelitis (OM) (382)(383)(384)(385)(386)(387)(388)(389)(390)(391)(392), native joint septic arthritis (393)(394)(395)(396)(397)(398)(399)(400)(401), and prosthetic joint infection (PJI) (402)(403)(404)(405)(406). As staphylococcal osteoarticular infections in children are common and have distinctive clinical and management issues compared to those in adults, we include an in-depth discussion of this important subpopulation.…”

Prosthetic Joint Infections

“…After treatment for 4-6 weeks with systemic antibiotics that are chosen based on antimicrobial susceptibilities, the joint spacer is removed and a new prosthetic joint is placed. [29,30,33,34] This two-stage protocol is successful in treating 84-96% of patients with infected THA [35][36][37][38][39] and 84-97% of subjects with infected total knee arthroplasty (TKA). [39][40][41] Unfortunately, treatment regimens for infection by resistant organisms are less successful.…”

“…[29,30,33,34] This two-stage protocol is successful in treating 84-96% of patients with infected THA [35][36][37][38][39] and 84-97% of subjects with infected total knee arthroplasty (TKA). [39][40][41] Unfortunately, treatment regimens for infection by resistant organisms are less successful. Of 38 patients with methicillin-resistant S. aureus (MRSA) infection of THA who were treated with a two-stage exchange, 21% had recurrent infection requiring further revision surgery.…”