A Treatment Pathway Variation for Chronic Prosthesis-Associated Infections

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Arthroplasty

Background:

• Periprosthetic joint infections (PJIs) are increasing due to more joint implantations.
• PJI treatment is complex and individualized, depending on infection severity and causative agents.

Purpose of the Study:

• To investigate the clinical and functional outcomes of a modified Liestal algorithm for treating chronic hip PJI.
• To evaluate a specific two-stage exchange protocol for PJI management.

Main Methods:

• A case series of 32 patients (33 cases) with chronic PJI undergoing two-stage exchange with a cement spacer (2003-2014).
• Protocol included early targeted antibiotics, second-look surgery 4 days post-explant, a 4-week antibiotic-free window, and ~6 weeks of post-reimplantation antibiotics.
• Minimum 2-year follow-up assessing infection-free survival and functional outcomes (Harris Hip Score).

Main Results:

• 100% of patients remained infection-free at 2 years and an average of 7 years post-reimplantation.
• Mean Harris Hip Score (HHS) was 89 at the latest follow-up, indicating good functional recovery.

Conclusions:

• A meticulously performed two-stage exchange for PJI, incorporating early targeted antibiotics and specific surgical timing, yields excellent infection control.
• This modified approach provides good functional outcomes for chronic PJI patients after a minimum of two years.