The success rates of two-stage revision arthroplasty for infection have evolved since their early description. The implementation of internationally accepted outcome criteria led to the readjustment of such rates. However, patients who do not undergo reimplantation are usually set aside from these calculations. The aim of this study was to investigate the outcomes of two-stage revision arthroplasty when considering those who do not undergo reimplantation, and to investigate the characteristics of this subgroup. A retrospective cohort study was conducted. Patients with chronic hip or knee periprosthetic joint infection (PJI) treated with two-stage revision between January 2010 and October 2018, with a minimum follow-up of one year, were included. Variables including demography, morbidity, microbiology, and outcome were collected. The primary endpoint was the eradication of infection. Patients who did not undergo reimplantation were analyzed in order to characterize this subgroup better.Aims
Methods
Gram negative bacteria (GNB) are emerging pathogens in chronic post-traumatic osteomyelitis. However, data on multi-drug (MDR) and extensively drug resistant (XDR) GNB are sparse. A multi-centre epidemiological study was performed in 10 countries by members of the ESGIAI (ESCMID Study Group on Implant Associated Infections). Osteosynthesis-associated osteomyelitis (OAO) of the lower extremities and MDR/XDR GNB were defined according to international guidelines. Data from 2000 to 2015 on demographics, clinical features, microbiology, surgical treatment and antimicrobial therapy were retrospectively analyzed. Cure was assessed after the end of treatment as the absence of any sign relevant to OAO. Factors associated with cure were evaluated by regression analysis.Aim
Methods
Data on Prosthetic joint infection (PJI) caused by multi-drug resistant (MDR) or XDR (extensively drug resistant) Gram negative bacteria (GNB) are limited. Treatment options are also restricted. We conducted a multi-national, multi-center assessment of clinical data and factors of outcome for these infections. PJI were defined upon international guidelines. Data from 2000–2015 on demographics, clinical features, microbiology, surgical treatment and antimicrobial therapy was collected retrospectively. Factors associated with treatment success were evaluated by logistic regression analysis.Aim
Method
This study evaluates the long-term survival of
spinal implants after surgical site infection (SSI) and the risk
factors associated with treatment failure. A Kaplan-Meier survival analysis was carried out on 43 patients
who had undergone a posterior spinal fusion with instrumentation
between January 2006 and December 2008, and who consecutively developed
an acute deep surgical site infection. All were appropriately treated
by surgical debridement with a tailored antibiotic program based
on culture results for a minimum of eight weeks. A ‘terminal event’ or failure of treatment was defined as implant
removal or death related to the SSI. The mean follow-up was 26 months
(1.03 to 50.9). A total of ten patients (23.3%) had a terminal event.
The rate of survival after the first debridement was 90.7% (95%
confidence interval (CI) 82.95 to 98.24) at six months, 85.4% (95%
CI 74.64 to 96.18) at one year, and 73.2% (95% CI 58.70 to 87.78)
at two, three and four years. Four of nine patients required re-instrumentation
after implant removal, and two of the four had a recurrent infection
at the surgical site. There was one recurrence after implant removal
without re-instrumentation. Multivariate analysis revealed a significant risk of treatment
failure in patients who developed sepsis (hazard ratio (HR) 12.5
(95% confidence interval (CI) 2.6 to 59.9); p <
0.001) or who
had >
three fused segments (HR 4.5 (95% CI 1.25 to 24.05); p = 0.03).
Implant survival is seriously compromised even after properly treated
surgical site infection, but progressively decreases over the first
24 months. Cite this article:
Successful treatment of prosthetic joint infections (PJIs) requires surgical intervention and prolonged antimicrobial therapy (AT), although the most suitable management has not been clearly defined yet. The aim of the study is to review our experience in the management of AHPJIs. From 01/01/2004 to 31/12/2006 all patients with PJIs were prospectively evaluated in 8 Spanish hospitals by the REIPI. We focused here on AHPJIs. Diagnostic of infection was based on clinical-microbiological evidence. Forty-nine patients, 30 (61.2%) women, median age: 75.35 years (range: 31–92), were diagnosed of AHPJIs: 22 (44.8%) hips, 26 (53%) knees and 1 (2%) elbow implants. Following total joint replacement our patients had a median infection-free period of 4.9 years (range 0.3 to 18.7). The comorbidities were: 9 (18.3%) rheumatoid arthritis, 7 (14.3%) diabetes, and 6 (12.2%) chronic renal failure. Clinical features were acute in all cases: pain 100%, inflammatory signs 75.5%, and fever 70%. In 27 (55%) of the cases a distant previous infection caused by the same microorganism could be identified. The etiology was: S. aureus 18 (36.7%), streptococcal infections 13 (26.5%), coagulase-negative staphylococci 2 (4%), gram-negative bacilli 11 (22.4%), anaerobes 2 (4%), and mixed infections in 3 (6.1%) cases. Thirty (61.1%) patients underwent early drainage/debridement with retention of the implant, 11 (22.4%) two-stage replacement, 6 (12.5%) arthrodesis, 1 (2.1%) resection arthroplasty, and 1 unknown. Patients were treated with specific AT (median duration of 10.6 weeks) according to the isolated microorganism. At 1 year follow-up 25 (51%) were cured, 7 (14.3%) relapsed after a conservative approach (3 required an arthrodesis and 1 a two-stage replacement), 5 (10.2 %) died and 5 (10.2%) had a re-infection; in 7 the evolution was unknown. AHPJs can be successfully treated in most cases with surgical debridement plus an antibiotic course. If a relapse is observed, removal of the prostheses could be necessary.
