High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage e
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(2019) 14:78
RESEARCH ARTICLE
Open Access
High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange Doruk Akgün1,2*, Michael Müller1, Carsten Perka1 and Tobias Winkler1
Abstract Background: Two-stage exchange arthroplasty is still the preferred treatment choice for chronic PJI. However, the results remain unpredictable. We analyzed the treatment success of patients with an infected hip prosthesis, who were treated according to a standardized algorithm with a multidisciplinary team approach and evaluated with a strict definition of failure. Methods: In this single-center prospective cohort study, all hip PJI episodes from March 2013 to May 2015 were included. Treatment failure was assessed according to the Delphi-based consensus definition. The Kaplan-Meier survival method was used to estimate the probability of infection-free survival. Patients were dichotomized into two groups depending on the number of previous septic revisions, duration of prosthesis-free interval, positive culture with difficult-to-treat microorganisms, microbiology at explantation, and microbiology at reimplantation. Results: Eighty-four patients with hip PJI were the subject of this study. The most common isolated microorganisms were coagulase-negative staphylococci (CNS) followed by Staphylococcus aureus and Propionibacterium. Almost half of the study cohort (46%) had at least one previous septic revision before admission. The Kaplan-Meier estimated infection-free survival after 3 years was 89.3% (95% CI, 80% to 94%) with 30 patients at risk. The mean follow-up was 33.1 months (range, 24–48 months) with successful treatment of PJI. There were no statistical differences in infect eradication rate among the dichotomized groups. Conclusions: High infect eradication rates were achieved in a challenging cohort using a standardized two-stage exchange supported by a multidisciplinary approach. Keywords: Hip, Outcome, Periprosthetic joint infection, Two-stage exchange
Introduction Periprosthetic joint infection (PJI) is a serious and challenging complication following total hip arthroplasty (THA). Despite developments in preventative medicine and identification of multiple risk factors, the incidence of PJI is still around 1% following primary THA [1]. With the growing numbers of THA each year [2, 3], the total number of PJI is also rising, with nearly 52,000 registered * Correspondence: [email protected] 1 Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany 2 Charite Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany
revisions for hip PJI in the USA performed between January 1, 2009, and December 31, 2013 [2]. Although the best treatment option of PJI is unclear, two-stage exchange arthroplasty is still the preferred treatment choice for chronic PJI [4] associated with high eradication rates around 90% [5–7]
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