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Published on: December 3, 2017
Is Preoperative Identification of the Infecting Organism Essential Before Single-Stage Revision Hip Arthroplasty for
Benjamin J Greenfield1, Henry Wynn Jones2, Paul D Siney2
1School of Medical Sciences, Stopford Building, The University Of Manchester, Manchester.
Background:
It is commonly stated that identification of the infecting organism is a prerequisite to single-stage revision arthroplasty of the hip for deep infection. We have performed single-stage revision in a series of patients where the organism was not identified preoperatively. The aim of this study is to investigate whether the rate of infection eradication following single-stage revision was affected by preoperative knowledge of the infecting organism.
Methods:
We identified all patients who had undergone a single-stage revision for a deep infection at our hospital between 2006 and 2015. One hundred five patients were assigned into 2 groups based upon whether the infecting organism had been identified preoperatively (group A = 28) or not (group B = 77).
Results:
The reinfection rates were 3.6% in group A and 9.1% for group B (P = .679). Re-revision rates were 7.1% and 9.1%, respectively (P = 1.00). Overall, the implant survival rate at 6 years was 87.9% (95% confidence interval, 97.4-78.4). In group B, preoperative aspiration was performed in 36.4% (28/77) of cases. Staphylococci species were the predominant causative organisms, with gram-negative involvement in 19.0% (20/105) of cases.
Conclusion:
The rate of infection eradication and overall survivorship with single-stage revision was similar in our series to that reported in the literature. While desirable, we did not find identification of the infecting organism before surgery influenced the outcome. Given the functional and economic benefits of single-stage revision, we suggest that failure to identify an organism is not an absolute contraindication to this approach.
Insights
Preoperative identification of the infecting organism is not essential for successful single-stage revision hip arthroplasty for deep infection. Outcomes were similar regardless of whether the pathogen was identified beforehand.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Management
- Arthroplasty Research
Background:
- Deep infection following hip arthroplasty necessitates revision surgery.
- Single-stage revision arthroplasty is an option for managing these infections.
- Preoperative identification of the causative organism is often considered crucial.
Purpose of the Study:
- To evaluate if preoperative knowledge of the infecting organism impacts single-stage revision success.
- To compare infection eradication rates in patients with and without identified preoperative pathogens.
Main Methods:
- Retrospective analysis of 105 patients undergoing single-stage revision for deep hip infection (2006-2015).
- Patients were divided into two groups: organism identified preoperatively (Group A, n=28) and not identified (Group B, n=77).
- Outcomes assessed included reinfection rates, re-revision rates, and implant survival.
Main Results:
- Reinfection rates were 3.6% (Group A) and 9.1% (Group B), with no statistically significant difference (P=.679).
- Re-revision rates were 7.1% (Group A) and 9.1% (Group B) (P=1.00).
- Overall implant survival at 6 years was 87.9%; Staphylococci were predominant organisms.
Conclusions:
- Single-stage revision for deep hip infection can achieve successful outcomes without mandatory preoperative organism identification.
- Failure to identify the pathogen preoperatively should not preclude single-stage revision surgery.
- The study supports the functional and economic advantages of single-stage revision, even with unknown preoperative pathogens.
