Complications - InfectionPatients With Failed Prior Two-Stage Exchange Have Poor Outcomes After Further Surgical Intervention
Section snippets
Study Design
After the institutional review board's approval, 482 patients (178 hips and 326 knees) who underwent 2-stage exchange arthroplasty between 1999 and 2013 at our institution were identified using our PJI database. Among the cohort, 59 patients (60 joints, 42 knees, and 18 hips) experienced failure of the 2-stage exchange and required further surgical intervention. Patients were included if they completed the reimplantation stage of a 2-stage exchange arthroplasty, met the International Consensus
Results
Of the 40 patients in our cohort who underwent an intended 2-stage exchange for repeat PJI, only 26 (65%) completed a second 2-stage exchange. Treatment success in this subset of patients was 62% (16/26). Of the ten cases that failed, 9 were reinfected and 1 patient died due to PJI. Of the 9 who were reinfected, one was reinfected with the same organism, one remained culture-negative, and the rest developed an infection with a different organism than their initial PJI. Staphylococcus was the
Discussion
In our study, further surgical intervention after a failed prior 2-stage exchange is associated with a high complication rate and dismal outcomes regardless of treatment choice. I&D has a high failure rate and many of the patients who are deemed candidates for a second 2-stage exchange either do not undergo reimplantation for various reasons or fail after reimplantation. In addition, high rates of spacer exchanges, complications, and salvage procedures were also demonstrated.
Prior studies
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One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.10.008.