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Published on: December 3, 2017
Spacer exchange in persistent periprosthetic joint infection: microbiological evaluation and survivorship analysis
Antonio Clemente1,2, Luca Cavagnaro3, Antonio Russo4,5
1Department of Orthopedics and Traumatology, C.T.O. Hospital, via G. Zuretti 29, 10126, Turin, Italy. antonioclemente.ort@gmail.com.
Purpose:
The purposes of this study were to determine demographics and characteristics of patients who underwent spacer exchange for persistent infection in the setting of two-stage arthroplasty for periprosthetic joint infection, to describe the microbiology of pathogens involved, to analyze survivorship free from infection in these patients.
Methods:
The institutional prospectively collected database was reviewed to enroll patients with minimum 2 years follow-up. Patients who underwent two-stage procedure for septic arthritis were excluded, as were patients who had spacer fracture or dislocation.
Results:
A total of 34 patients (41 procedures) were included. Mean age was 65.0 ± 12.8 years. Mean follow-up was 53.4 ± 24.8 months. Mean number of previous procedures was 3.6 ± 1.2. A total of 27 (79.4%) patients underwent final reimplantation. The most frequently isolated pathogen in spacer exchange was Staphylococcus epidermidis (10 cases, 28.6%). Polymicrobial cultures were obtained from 9 (25.71%) patients, 10 (28.6%) presented culture-negative infections. A total of 11 (32.4%) resistant pathogens were isolated, and 16 (47.0%) difficult to treat pathogens were detected. Eradication rate was 78.8%. Overall survivorship of implants after final reimplantation was 72.8% at 51.8 months.
Conclusion:
Surgeons should be aware that subjects necessitating spacer exchange often present multiple comorbidities, previous staged revision failures, soft-tissue impairment and difficult to treat infection. In these patients, spacer exchange provides good clinical results and infection eradication, preventing arthrodesis or amputation.
Insights
Spacer exchange for persistent periprosthetic joint infection in two-stage arthroplasty shows good infection eradication rates (78.8%) and implant survivorship (72.8%). This procedure is effective in preventing further surgeries like arthrodesis or amputation.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Biomedical Engineering
Background:
- Periprosthetic joint infection (PJI) is a serious complication of arthroplasty.
- Two-stage arthroplasty with an articulating spacer is a common treatment for PJI.
- Persistent infection may necessitate further intervention, such as spacer exchange.
Purpose of the Study:
- To determine demographics and characteristics of patients undergoing spacer exchange for persistent PJI after two-stage arthroplasty.
- To describe the microbiology of pathogens involved in these cases.
- To analyze infection-free survivorship following spacer exchange and subsequent reimplantation.
Main Methods:
- Review of a prospectively collected institutional database.
- Inclusion of patients with a minimum of 2 years follow-up.
- Exclusion of patients with spacer fracture, dislocation, or initial two-stage septic arthritis.
Main Results:
- 34 patients (41 procedures) were analyzed, with a mean age of 65 years and 53.4 months follow-up.
- Staphylococcus epidermidis was the most common pathogen (28.6%); 25.71% had polymicrobial infections, and 28.6% were culture-negative.
- An infection eradication rate of 78.8% and implant survivorship of 72.8% at 51.8 months were observed after final reimplantation.
Conclusions:
- Patients requiring spacer exchange often have comorbidities and treatment failures.
- Spacer exchange offers favorable clinical outcomes and infection control, avoiding arthrodesis or amputation.
- Surgeons must consider these complex patient factors when planning treatment for persistent PJI.
