Abstract
Aim
We wonder what the results of two stage procedures were in terms of morbidity (amputation, dead) and infection recurrence. We also seek to identify risk factors for failure and see if the results of a second two stage surgery were not even worse.
Material and Methods
We retrospectively reviewed 140 prosthetic joint infection (PJI) treated with a two stage procedure. Patient data has been reviewed to determine which factors would be predictive for failure.
Results
From the 140 two stages, 98 patients were infection free at two years. Four died in the following year. 38 patients presented a recurrence within the two years: 2 died and 1 was amputated within one year. Nine were further treated with a second two stage procedure and 26 with debridement and implant retention procedures and antibiotics (DAIR). Six of these last received long terms suppressive antibiotics. In total 27 from the 38 were again diseases free at two years follow up.
The dead and amputation rates are 4,3% and 0,8 % respectively. The rate of success after the first two stage was 80% and after a second two stage procedure 78%. The final rate of PJI cured is 89,3%.
The only difference observed between success and failure after a first two stage procedure was related to microbiology. Polymicrobial infection was 28.6% of the PJI which will fail and only 14,1% in those whose treatment will succeed (p<0.05). Looking to the patients that underwent a second two stage surgery, recurrence involved monomicrobial pattern with a microorganism that has developed a resistance to quinolones.
Conclusion
Mortality and amputation in PJI management should be mentioned to patients as significant potential complications. Infection control within a two stage procedure is not as high as reported, unless the final result is considered after secondary procedures. A second two stage procedure was not related with a worse outcome.
Our data confirms the poorer outcome of polymicrobial infection. Recurrence in those patients involves monomicrobial infections with resistant microorganisms. Nevertheless, a second two stage procedure appears acceptable when a DAIR procedure and suppressive antibiotherapy is difficult or impossible due to the microorganism resistance profile.
