Abstract
Aim
Acute hematogenous periprosthetic joint infection (AHI) is a diagnosis on the rise. The management is challenging and the optimum treatment is not clearly defined. The purpose of this study was to evaluate the characteristics of AHI, and to study risk factors affecting treatment outcome.
Methods
We retrospectively analysed 44 consecutive episodes with AHI in a total hip or knee arthroplasty beween 2013 and 2020 at a single center. AHI was defined as abrupt symptoms of infection ≥ 3 months after implantation in an otherwise well functioning arthroplasty. We used the Delphi criteria to define treatment failure with a minimum of 1-year follow-up.
Results
AIH was most often caused by Staphylococcus aureus (36%) and streptococcal species (32%), but a broad spectrum of microbes were identified. The majority of patients (25/44) were treated with debridement and retention of the implant (DAIR), with a success rate of 40%, significantly lower than in patients treated with removal of the implant (94%, p=0.001). Staph aureus infections (p=0.004), knee arthroplasties (p=0.03), and implant-age < 2 years (p=0.034) were associated with treatment failure. The 2-year mortality rate was 19%.
Conclusions
The main findings in this study were that outcome following DAIR in AHIs is poor, that the majority of infections were caused by virulent microbes, and we found a high mortality rate. Removal of the implant should more often be considered.
