Outcome of infected total joint replacement

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Biomaterials Science

Background:

• Deep infection following total joint arthroplasty (TJA) is a significant complication.
• Various treatment protocols exist, including resection, one-stage, and two-stage reimplantation arthroplasty.
• Understanding long-term survival outcomes is crucial for optimizing treatment strategies.

Purpose of the Study:

• To evaluate and compare the survival outcomes of different treatment protocols for infected total joint arthroplasty over a 35-year period.
• To determine if any specific treatment modality demonstrates superior effectiveness in managing deep prosthetic joint infections.

Main Methods:

• Retrospective analysis of 17,561 total joint arthroplasties, identifying 116 cases (0.66%) with deep infection.
• Comparison of success rates for resection, one-stage, and two-stage reimplantation arthroplasty across hip and knee joints.
• Analysis of organism types and their impact on treatment success, excluding early mortality and lost follow-up cases.

Main Results:

• Two-stage reimplantation achieved 82.4% success in hips and 66.7% in knees after the second attempt.
• One-stage reimplantation had limited success (5/5 hips, 1/3 knees) and was not used for hematogenous infections.
• No significant difference in survival rates was observed based on the type of bacteria involved.
• Third treatment attempts following failure of the second attempt did not yield successful outcomes.

Conclusions:

• Treatment of deep prosthetic joint infection becomes increasingly difficult after the failure of initial interventions.
• Two-stage reimplantation arthroplasty provides favorable outcomes for infected TJAs, particularly in hips.
• Further surgical attempts beyond the second stage do not appear to improve success rates for infected joint replacements.