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Periprosthetic joint infection treated via bone cement and without the removal of hardware
1Department of Orthopedics and Traumatology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
Abstract:
Periprosthetic joint infection (PJI) is a challenging complication with a frequency of 0.5-3%. The patient's age, recurrent surgeries, and comorbid systemic diseases increase the risk of infection. Although the current approach in the treatment of PJI is a two-stage revision; sometimes, removing all the implants can lead to more serious complications. PJI's complications are increase in the time of surgery, loss of blood volume, and increase in the amount of bone loss. Infected soft tissue and dead bone tissue debridement must be made in all cases. One of our cases had bone defects due to recurrent hip arthroplasty revisions. Our case that was given PJI treatment by covering the well-fixed components with bone cement and removing only the mobile parts was discussed in line with the literature.
Insights
Periprosthetic joint infection (PJI) treatment can be complex. This study explores a modified approach for PJI, preserving well-fixed implants to mitigate complications like bone loss.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomaterials Science
Background:
- Periprosthetic joint infection (PJI) affects 0.5-3% of patients, with risks amplified by age, prior surgeries, and systemic diseases.
- Standard two-stage revision for PJI can lead to significant complications, including extended surgery time, blood loss, and bone defects.
- Effective debridement of infected soft tissue and necrotic bone is crucial in all PJI cases.
Purpose of the Study:
- To evaluate a modified treatment strategy for PJI involving the retention of well-fixed implants.
- To present a case study of PJI management in a patient with significant bone defects from recurrent hip arthroplasty revisions.
- To discuss the feasibility and outcomes of preserving stable components in PJI treatment.
Main Methods:
- Surgical debridement of infected soft tissue and necrotic bone.
- Retention of well-fixed prosthetic components.
- Application of bone cement to cover retained components.
- Removal of only mobile or infected implant parts.
- Case presentation and literature review.
Main Results:
- The modified approach successfully managed PJI in a case with extensive bone defects.
- Preservation of well-fixed components potentially reduces surgical morbidity and bone loss compared to complete explantation.
- This strategy warrants further investigation as an alternative to traditional two-stage revision in select PJI cases.
Conclusions:
- A modified PJI treatment, preserving well-fixed components, can be a viable option, especially in complex cases with bone loss.
- This approach may mitigate complications associated with complete implant removal.
- Further research is needed to establish the long-term efficacy and indications for this PJI management strategy.
