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Published on: December 3, 2017
One-Stage Revision Total Hip Arthroplasty for Polymicrobial Periprosthetic Joint Infection Leads to High Reinfection
Graham S Goh1, Markus Neumann2, Jochen Salber3
1Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany; Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts.
Background:
Most surgeons traditionally recommend a two-stage exchange for patients who have polymicrobial periprosthetic joint infections (PJIs) because of the opportunity to obtain cultures. Consequently, outcome data on the one-stage strategy in this distinct population remains extremely limited. Given the renewed interest in one-stage revision, this study aimed to evaluate the mean 5-year results of patients who underwent one-stage revision THA for polymicrobial PJI.
Methods:
Patients who had polymicrobial PJI and who underwent one-stage revision THA between 2016 and 2022 were retrospectively reviewed using an institutional joint registry. A PJI was defined using the 2018 International Consensus Meeting criteria. In total, 65 patients had positive cultures isolating two or more distinct microorganisms. The mean age was 60 years, and 66% were women. The primary endpoint was the rate of septic failure. Mean follow-up was 5 years (range, one to 8).
Results:
The most common organism isolated was Staphylococcus epidermidis (n = 45, 69.2%), and the most common polymicrobial combination was Staphylococcus epidermidis and Cutibacterium acnes (n = 9; 13.8%). Survivorship free from all-cause revision was 79.7% (95% confidence interval 71.6 to 87.8), while survivorship free from septic failure was 66.9% (95% confidence interval 59.1 to 74.7). There were 17 septic failures with a mean time-to-failure of 1.8 years (range, 0.2 to 5.6), most of which (92.3%) isolated the same organisms as the initial one-stage revision.
Conclusions:
To our knowledge, this study represents the largest study reporting the outcomes of one-stage revision for polymicrobial PJI. Nearly one in three patients experienced septic failure at midterm follow-up. Future research should focus on identifying adjunctive therapies and optimizing selection criteria in patients who have polymicrobial PJI who undergo one-stage exchange arthroplasty.
Insights
One-stage revision hip arthroplasty for polymicrobial periprosthetic joint infection (PJI) shows a 66.9% success rate at 5 years, with nearly one-third experiencing septic failure. Further research is needed to improve outcomes for this challenging condition.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomaterials Science
Background:
- Polymicrobial periprosthetic joint infections (PJIs) traditionally treated with two-stage exchange.
- Limited outcome data exists for one-stage revision in polymicrobial PJI.
- Renewed interest in one-stage revision necessitates evaluation of its efficacy.
Purpose of the Study:
- Evaluate midterm (5-year) outcomes of one-stage revision total hip arthroplasty (THA) for polymicrobial PJI.
- Assess septic failure rates in patients undergoing this procedure.
- Contribute to understanding the effectiveness of one-stage revision for complex PJI.
Main Methods:
- Retrospective review of patients with polymicrobial PJI undergoing one-stage revision THA (2016-2022).
- PJI defined by 2018 International Consensus Meeting criteria.
- Analysis of 65 patients with cultures isolating two or more microorganisms; mean follow-up of 5 years.
Main Results:
- Survivorship free from septic failure was 66.9% (95% CI 59.1 to 74.7).
- 17 septic failures occurred, with a mean time to failure of 1.8 years.
- Most failures (92.3%) involved the same organisms as the initial infection.
Conclusions:
- This study is the largest to report outcomes of one-stage revision for polymicrobial PJI.
- A significant rate of septic failure (nearly one in three) was observed at midterm follow-up.
- Future research should explore adjunctive therapies and optimize patient selection for one-stage exchange arthroplasty in polymicrobial PJI.
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