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Published on: December 3, 2017
Treatment of periprosthetic hip infection caused by resistant microorganisms using 2-stage reimplantation protocol
Seung-Jae Lim1, Jae-Chul Park, Young-Wan Moon
1Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Abstract:
To determine the effectiveness of staged reimplantation for the treatment of periprosthetic hip infection caused by resistant microorganisms, we performed a retrospective case-control study on 37 consecutive patients who had a culture-proven periprosthetic hip infection treated using a 2-stage reimplantation protocol. Twenty-four patients infected by resistant microorganisms were compared with 13 patients infected by nonresistant microorganisms. The second-stage reimplantation procedure was possible in 34 (92%) of the 37 patients, but the remaining 3 required permanent resection because of persistent infection. At a mean follow-up of 4.4 years, there were 4 recurrent infections and 1 aseptic cup loosening. Overall treatment failure rate was 22%. All failures occurred only in the resistant microorganism group and none in the nonresistant microorganism group (33% vs 0%; P = .032). Current 2-stage reimplantation protocol showed a high rate of treatment failure in our patients with a periprosthetic hip infection caused by resistant microorganisms.
Insights
Two-stage reimplantation for periprosthetic hip infections caused by resistant microbes has a high failure rate. This protocol is less effective for resistant infections compared to non-resistant ones.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic hip infections pose a significant challenge in orthopedic surgery.
- Resistant microorganisms complicate treatment outcomes for these infections.
Purpose of the Study:
- To evaluate the efficacy of a two-stage reimplantation protocol for periprosthetic hip infections.
- To compare outcomes between infections caused by resistant and non-resistant microorganisms.
Main Methods:
- Retrospective case-control study of 37 patients with culture-proven periprosthetic hip infection.
- Comparison of 24 patients with resistant microorganisms versus 13 with non-resistant microorganisms.
- Analysis of treatment success, recurrence, and complications at a mean follow-up of 4.4 years.
Main Results:
- Two-stage reimplantation was successful in 92% of patients, with 3 requiring resection.
- Overall treatment failure rate was 22% (8 of 37 patients).
- All treatment failures (33%) occurred in the resistant microorganism group, versus 0% in the non-resistant group (P = .032).
Conclusions:
- The current two-stage reimplantation protocol demonstrates a high failure rate for periprosthetic hip infections caused by resistant microorganisms.
- Outcomes are significantly worse when resistant microbes are involved.
- Alternative or modified treatment strategies may be needed for resistant periprosthetic hip infections.
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