Abstract
Prosthetic joint infection (PJI) remains a devastating complication of arthroplasty. There is significant heterogeneity in treatment approaches to these infections and information on their efficacy relies on single-centre studies. This is the first multi-centre study examining current treatment approaches to patients with PJI.
A retrospective cohort study was conducted over a 3-year period (January 2006 – December 2008) involving 10 hospitals in Victoria, Australia. Cases of prosthetic joint infections of hips and knees were identified using an established statewide nosocomial infection surveillance network. Individual medical records were accessed to describe the management and record the outcomes of these patients.
Interim analysis from seven hospitals revealed 121 patients with PJI. Staphylococcus aureus was isolated in half of the infections with equal representation of methicillin resistant and methicillin sensitive strains. Debridement and retention (DR) was the most common treatment modality (72%), followed by resection arthroplasty without reimplantation (10%), superficial debridement and antibiotics (9%), one-stage exchange (6%) and two-stage exchange arthroplasty (3%). The timing and number of surgical interventions was however highly variable. The majority of patients underwent arthrotomy with an average of 3 debridements of the infected joint (range 0–10, standard deviation 1.7). Two-thirds of the patients with staphylococcal infections received a rifampicin-containing regimen. The course of oral antibiotic therapy was prolonged with a median duration of 132 days (interquartile range 13–357) but ranged from no oral antibiotic therapy to 1032 days. Overall 72% of patients remained infection-free after a mean follow-up of 15 months, however there was marked variation in outcomes between hospitals with success ranging from 50%-95%.
This multi-centre study demonstrates that there is a wide spectrum of treatment approaches to PJI. In addition, DR is the favoured treatment modality, which differs to our European and Northern American counterparts. This study reports real-life management and outcomes from patients at several centres, including many that do not have dedicated research interest in PJI.
