Changing Surgical Approach During Periprosthetic Joint Infection Treatment Does Not Increase Risk of Eradication...

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Arthroplasty

Background:

• Hip approach discordance is established as safe in aseptic revision total hip arthroplasty (THA).
• The safety and efficacy of changing surgical approach in periprosthetic joint infection (PJI) treatment remain uninvestigated.
• This study investigates approach discordance rates, associated factors, and outcomes in PJI treatment.

Purpose of the Study:

• To determine the rate of hip approach discordance during periprosthetic joint infection (PJI) treatment.
• To identify factors associated with approach discordance in PJI cases.
• To evaluate the association between approach discordance and treatment outcomes, including septic and aseptic failures.

Main Methods:

• A multicenter, consecutive-case series of 517 patients undergoing revision total hip arthroplasty (THA) for PJI.
• Data collected on patient demographics, primary THA approach, PJI treatment (DAIR, staged revision), and follow-up.
• Outcomes assessed included PJI treatment success (MSIS criteria) and aseptic complications (dislocation, fracture, loosening).

Main Results:

• Approach discordance occurred in 23.8% of cases, most frequently with anterior and lateral approaches.
• Approach change was more common in first-stage revisions compared to DAIR or single-stage revisions.
• PJI treatment success (87.2%) and aseptic complication rates (4.4%) were not significantly different between concordant and discordant approaches.

Conclusions:

• Changing surgical approach during periprosthetic joint infection (PJI) treatment yields comparable outcomes to maintaining the same approach.
• Approach discordance in PJI treatment is not associated with increased septic or aseptic risks.
• Surgeons can be reassured that altering the surgical approach is a safe and effective strategy for managing PJI.