Abstract
Introduction
Prosthetic joint infection (PJI) is an devastating complication after total hip arthroplasty (THA). The common treatment in the US is a two-stage exchange which can be associated with significant morbidity and mortality. The purpose of this study was to analyze complications in the treatment course of patients undergoing two-stage exchange for PJI THA and determine when they occur.
Methods
We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI after THA from January 2005 – December 2017 at a single institution. Complications were categorized as medical or surgical, divided into three intervals: (1) inter-stage, (2) early post-reimplantation (<90 days) and (3) late post-reimplantation (> 90 days). Minimum follow up was one year. Success was based on the Musculoskeletal Infection Society (MSIS) definition.
Results
185 hips underwent first stage of planned two stage exchange. The median age was 65 (IQR 18). There were 93 males and 92 females. 73 patients had a complication during treatment. 13.5% (25/185) of patients experienced a medical complication and 28.1% (52/185) a surgical complication. There was a 14.1% (26/185) mortality at a median of 2.5 years (IQR 4.9). 51(29%) had complications during the interstage period, most common being recurrence of infection requiring a spacer exchange (48.6%). 2 patients died and 2 patients failed to progress to the second stage. 22(12%) complications following re-implantation, most commonly persistence /recurrence of infection (31%). 183/185 patients that initiated a two stage exchange were re-implanted, only 65% (120/185) were successfully treated with or without antibiotic suppression at one-year without additional surgery.
Conclusions
While 2 stage exchanges for PJI in THA have been reported as successful, there are few reports of the complications during the process. In our series, significant numbers of patients experienced complications, often during the interstage period, highlighting the morbidity of this method of treatment.
