Abstract
Aim
This study aims to describe our department experience with single stage revision (SSR) for chronic prosthetic-joint infection (PJI) after total hip arthroplasty (THA) between 2005 and 2014 and to analyze success rates and morbidity results of patients submitted to SSR for infected THA according to pathogen.
Method
We retrospectively reviewed our 10 years of results (2005–2014) of patients submitted to SSR of the hip combined with IV and oral antibiotic therapy for treatment of chronic PJI (at least 4 weeks of symptoms), with a minimum follow-up of four years (n=26). Patients were characterized for demographic data, comorbidities, identified germ and antibiotic therapy applied (empiric and/or targeted). Outcomes analyzed were re-intervention rate (infection-related or aseptic), success rate (clinical and laboratory assessment), length of stay, morbidity and mortality outcomes.
Results
In this period, 26 single-stage revisions for chronic PJI of the hip were performed. Patients average age was 72 years (range 44–82). Ten patients were women. The average time of follow up was 69 months (range 4 to 12 years). The most commonly isolated bacteria were coagulase-negative Staphylococci (30%), methicillin-resistant Staphylococcus aureus (MRSA) (18%) and methicillin-sensitive Staphylococcus aureus (15%). It wasn't possible to identify the germ in 19% of the patients and other 23% were polymicrobial. Targeted antibiotic therapy was administered to 73% of patients and the most used targeted antibiotics were Vancomycin (53%), Linezolid (32%) and Rifampicin (21%). Mean length of stay was 25 days. In the follow-up period, 9 patients (35%) required a re-intervention for infection relapse. Two patients (8%) needed surgery because of persistent instability. During the follow-up period, the infection-free survival was 65% (33% for MRSA; 82% for coagulase-negative Staphylococci) and the surgery-free survival was 62%. Six patients (23%) died during the follow-up, all due to other medical conditions not related to hip infection.
Conclusions
Our experience suggests that SSR is associated with good outcomes and low re-intervention rate, except in the case of infection due to MRSA. In this last group, the results were significantly poorer, what leads to suggest that a two-stage revision may be a better option. The potential advantages of a SSR include good rates of infection eradication, a decrease in surgical morbidity and mortality as well as a decrease in healthcare and global economic costs. As such, a one-stage aggressive surgical attitude in addition to targeted antibiotherapy seems to be a suitable solution in selected patients.
