Aim

Cutibacterium acnes is a significant cause of late-onset spinal implant infection (SII). In addition, usual preoperative prophylactic measures may be insufficient to prevent C. acnes operating site colonisation and infection, as demonstrated for prosthetic shoulder surgery. However, little information is available regarding risk factors for SII due to this microorganism. The aims of this study were to determine the characteristics of and risk factors for C. acnes SII.

Purpose: We studied a consecutive multicentric series retrospectively to assess outcome after one-stage revision total hip arthroplasty without cement for infection-related failed total hip arthroplasty in patients with chronic infection (> 30 days).

Material and method: Thirty-four patients (12 women and 22 men) underwent primary arthroplasty between 1992 and 1998. Mean age was 67.8 years (range 45 – 89). Indications were primary hip degeneration (n=17), neck fracture (n=5), secondary hip degeneration (n=12). Twenty-two patients had risk factors for infection. The same treatment protocol was used for all patients: single-phase replacement of the infected implant with insertion of a hydroxyapatite coated implant without cement and a three-month antibiotic regimen adapted to intraoperative samples. Seven femorotomies were performed. Clinical, laboratory and radiological findings were used to assess outcome. Patients were considered to be cured when laboratory tests were normal and x-rays showed no signs of suspected complications.

Results: There were three failures and 31 successful revisions. Intraoperative fracture of the femur required osteosynthesis in six patients. five patients developed a drug-related complication. Isolated germs were: meticillin-sensitive staphylococcus (n=18), meticillin-resistant staphylococcus (n=6), multiple germs (n=2), other germs (n=6), undetermined (n=2). The three failures occurred in patients with meticillin-resistant staphylococcal infections.

Discussion and conclusion: Our 88% success rate is in line with data in the literature. For us, one-phase revision is the best first intention option: other techniques may be required for patients with severe infections, after failure of one-stage revision, or massive loss of bone stock. Based on the present results, we have continued to prefer this therapeutic option but long-term follow-up is needed to further support these early findings.

Purpose: We report a retrospective monocentric evaluation of surgical lavage for early infection(≤ 30 days) after total hip arthroplasty.

Material and methods: Thirty-four patients, mean age 67.8± 12.1 years) who developed grade II infection in the Gustillo and Tsukayama classification were treated between 1992 and 1995 by surgical debridement and adapted antibiotherapy for a limited duration. Arthroplasty was indicated for primary hip degeneration (n=17), secondary hip degeneration (n=11), or neck fracture (n=6). There were 25 first-intention arthroplasties and nine revision arthroplasties. Seventeen patients had risk factors for infection.

All patient were followed for at least four years. Therapeutic efficacy was assessed on the basis of clinical and laboratory findings and radiographic results. We searched for biological or bacteriological factors predictive of good outcome. The chi-square test and Fisher exact tet were used to compare population distributions and Student’s t test and Mann Whitney test to compare means.

Results: Mean follow-up was five year, 74% of the patients developed recurrent infection. A second treatment protocol was implemented for only 56% of these patients and was effective against the infection and satisfactory for functional outcome (28% of the patients underwent revision for extraction of the prosthesis and 16% were given continuous antibiotics). There was a significant difference in the efficacy of the surgical lavage for delay ≤ 21 days (p = 0.02). Statistical analysis suggested the type of germ (p = 0.006), and presence of risk factors (p= 0.0052) had a significant influence.

Discussion: Attractive because minimally invasive, surgical lavage appears to limit acute symptoms without eradicating infection. Furthermore, if the failure is recognised late after infection has become chronic, the efficacy of revision is compromised and may lead to poor mid-term function. Like other authors, we identified delay to treatment as the one significant factor. These poor results have incited us to limit indications for surgical lavage to cases of infection diagnosed very early, programming secondary revision for very debilitated patients. Close and prolonged follow-up is indispensable.