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International Orthopaedics

Erschienen in:

04.01.2020 | Original Paper

Partial implant retention in two-stage exchange for chronic infected total hip arthroplasty

verfasst von: Xiaojun Shi, Jing Yang, Zongke Zhou, Bin Shen, Pengde Kang, Fuxing Pei

Erschienen in: International Orthopaedics | Ausgabe 3/2020

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Abstract

Background

The efficacy of partial retention of well-fixed components during two-stage exchange for chronic total hip arthroplasty (THA) infection has remained unknown.

Methods

A total of 14 patients with chronic infected THA were treated with damage control two-stage revision, including selective retention of the well-fixed femoral or acetabular component, aggressive debridement, antibiotic-laden cement spacer, antibiotic therapy, and delayed reimplantation. Indications for this treatment included chronic infected THAs with ingrown femoral or acetabular component and positive microbial growth with sensitive antibiotics. We excluded patients with acute infection; negative microbial growth; positive pathogen with high-virulence bacterial infections and multiple drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus, fungi, and Mycobacterium tuberculosis; sinus formation; a prior failure for periprosthetic joint infection (PJI) treatment; and obvious bone resorption in both femoral and acetabulum side. During the study period, this represented 3.3% (14/425) of the patients treated for infected THA. Minimum follow-up was three years. None of the 14 patients in this series were lost to follow-up. Successful treatment was defined according to a modified Delphi-based international multidisciplinary consensus.

Results

No repeated debridement and recurrence of infection occurred during the study period; no patient need chronic antibiotic suppression. Successful treatment of chronic PJI was achieved in all patients. Despite the high peri-operative complication rate, no severe consequences were observed. The mean Harris Hip Score was 86 (range, 82–92; SD, 3.3).

Conclusions

The selective partial implant retention two-stage revision for chronic PJI may be a treatment option in properly selected patients with low virulence bugs.

Del Pozo JL, Patel R (2009) Clinical practice. Infection associated with prosthetic joints. N Engl J Med 361:787–794PubMed

Jacobs AM, Benard M, Meis F, van Hellemondt G, Goosen JHM (2017) The unsuspected prosthetic joint infection: incidence and consequences of positive intraoperative cultures in presumed aseptic knee and hip revision. Bone Joint J 99:1482–1489PubMed

Kamath AF, Ong KL, Lau E, ChanV VTP, Rubash HE et al (2015) Quantifying the burden of revision total joint arthroplasty for periprosthetic infection. J Arthroplast 30:1492–1497

Kurtz SM, Lau E, Waston H, Schmier JK, Parvizi J (2012) Economic burden of periprosthetic joint infection in the United States. J Arthroplast 27:61–65

Tan TL, Maltenfort MG, Chen AF, Shahi A, Higuera CA, Siqueira M et al (2018) Development and evaluation of a preoperative risk calculator for periprosthetic joint infection following total joint arthropalsty. J Bone Joint Surg Am 100:777–785PubMed

Berger P, Van Cauter M, Driesen R, Cornu O, Bellemans J (2017) Diagnosis of prosthetic joint infection with alpha-defensin using a lateral flow device. Bone Joint J 99:1176–1182PubMed

Ottink KD, Wouthuyzen-Bakker M, Kampinga GA, Jutte PC, Ploegmakers J (2018) Puncture protocol in the diagnostic work-up of a suspected chronic prosthetic joint infection of the hip. J Arthroplast 33:1904–1907

Shahi A, Kheir MM, Tarabchi M, Hosseinzadeh HRS, Tan TL, Parvizi J (2017) Serum D-dimer test is promising for the diagnosis of periprosthetic joint infection and timing of reimplantation. J Bone Joint Surg Am 99:1419–1427PubMed

Zmistowski B, Karam JA, Durinka JB, Casper DS, Parvizi J (2013) Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am 95:2177–2184PubMed

10.

Whiteside LA, Roy ME (2017) One-stage revision with catheter infusion of intraarticular antibiotics successfully treats infected THA. Clin Orthop Relat Res 475:419–429PubMed

11.

Urish KL, DeMuth PW, Kwan BW, Craft DW, Ma D, Haider H et al (2016) Antibiotic-tolerant staphylococcus aureus biofilm persists on arthroplasty materials. Clin Orthop Relat Res 474:1649–1656PubMedPubMedCentral

12.

Berend KR, Lombardi AV Jr, Morris MJ, Bergeson AG, Adams JB, Sneller MA (2013) Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res 471:510–518PubMed

13.

Camurcu Y, Sofu H, Buyuk AF, Gursu S, Kaygusuz MA, Sahin V (2015) Two-stage cementless revision total hip arthroplasty for infected primary hip arthroplasties. J Arthroplast 30:1597–1601

14.

Ji B, Zhang X, Xu B, Guo W, Mu W, Cao L (2017) Single-stage revision for chronic fungal periprosthetic joint infection: an average of 5 years of follow-up. J Arthroplast 32:2523–2530

15.

Shi X, Zhou Z, Shen B, Yang J, Kang P, Pei F (2019) The use of extended trochanteric osteotomy in 2-stage reconstruction of the hip for infection. J Arthroplast 34:1470–1475

16.

Sambandam SN, Duraisamy G, Chandrasekaran J, Mounasamy V (2016) Extended trochanteric osteotomy: current concepts review. Eur J Orthop Surg Traumatol 26:231–245PubMed

17.

Chen KH, Tsai SW, Wu PK, Chen CF, Wang HY, Chen WM (2017) Partial component-retained two-stage reconstruction for chronic infection after uncemented total hip arthroplasty: results of sixteen cases after five years of follow-up. Int Orthop 41:2479–2486PubMed

18.

Ekpo TE, Berend KR, Morris MJ, Adams JB, Lombardi AV Jr (2014) Partial two-stage exchange for infected total hip arthroplasty: a preliminary report. Clin Orthop Relat Res 472:437–448PubMed

19.

Lombardi AV Jr, Berend KR, Adams JB (2014) Partial two-stage exchange of the infected total hip replacement using disposable spacer moulds. Bone Joint J 96:66–69PubMed

20.

EI-Husseiny M, Haddad FS (2016) The role of highly selective implant retention in the infected hip arthroplasty. Clin Orthop Relat Res 474:2157–2163

21.

Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351:1645–1654PubMed

22.

Della Valle CJ, Bogner E, Desai P, Lonner JH, Adler E, Zuckerman JD et al (1999) Analysis of frozen sections of intraoperative specimens obtained at the time of reoperation after hip or knee resection arthroplasty for the treatment of infection. J Bone Joint Surg Am 81:684–689PubMed

23.

Johnston RC, Fitzgerald RH Jr, Harris WH, Poss R, Muller ME, Sledge CB (1990) Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Joint Surg Am 72:161–168

24.

Akgun D, Muller M, Perka C, Winkler T (2017) A positive bacterial culture during re-implantation is associated with a poor outcome in two-stage exchange arthroplasty for deep infection. Bone Joint J 99:1490–1495PubMed

25.

Diaz-Ledezma C, Higuera CA, Parvizi J (2013) Success after treatment of periprosthetic joint infection: a Delphi-based international multidisciplinary consensus. Clin Orthop Relat Res 471:2374–2382PubMedPubMedCentral

26.

Engh CA, Bobyn JD, Glassman AH (1987) Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br 69:45–55PubMed

27.

Grant TW, Lovro LR, Licini DJ, Warth LC, Ziemba-Davis M, Meneghini RM (2017) Cementless tapered wedge femoral stems decrease subsidence in obese patients compared to traditional fit-and-fill stems. J Arthroplast 32:891–897

28.

Pak JH, Paprosky WG, Jablonsky WS, Lawrence JM (1993) Femoral strut allografts in cementless revision total hip arthroplasty. Clin Orthop Relat Res 295:172–178

29.

Ibrahim MS, Twaij H, Haddad FS (2018) Two-stage revision for the culture-negative infected total hip arthroplasty: a comparative study. Bone Joint J 100:3–8PubMed

30.

Hsieh PH, Shih CH, Chang YH, Lee MS, Yang WE, Shih HN (2005) Treatment of deep infection of the hip associated with massive bone loss: two-stage revision with an antibiotic-loaded interim cement prosthesis followed by reconstruction with allograft. J Bone Joint Surg Br 87:770–775PubMed

31.

Gundtoft PH, Pedersen AB, Varnum C, Overgaard S (2017) Increased mortality after prosthetic joint infection in primary THA. Clin Orthop Relat Res 475:2623–2631PubMedPubMedCentral

32.

Anagnostakos K, Jung J, Kelm J, Schmitt E (2010) Two-stage treatment protocol for isolated septic acetabular cup loosening. Hip Int 20:320–326PubMed

33.

Faroug R, Shah Y, McCarthy M, Halawa M (2009) Two stage one component revision in infected total hip replacement-two case reports and literature review. Hip Int 19:292–298PubMed

34.

Fukui K, Kaneuji A, Ueda S, Matsumoto T (2015) Should well-fixed uncemented femoral components be revised in infected hip arthroplasty? Report of five trial cases. J Orthop 13:437–442PubMedPubMedCentral

35.

Lee YK, Lee KH, Nho JH, Ha YC, Koo KH (2013) Retaining well-fixed cementless stem in the treatment of infected hip arthroplasty. Good results in 19 patients followed for mean 4 years. Acta Orthop 84:260–264PubMedPubMedCentral

36.

Morley JR, Blake SM, Hubble MJW, Timperley AJ, Gie GA, Howell JR (2012) Preservation of the original femoral cement mantle during the management of infected cemented total hip replacement by two-stage revision. J Bone Joint Surg Br 94:322–327PubMed

37.

Bryan AJ, Abdel MP, Sanders TL, Fitzgerald SF, Hanssen AD, Berry DJ (2017) Irrigation and debridement with component retention for acute infection after hip arthroplasty: improved results with contemporary management. J Bone Joint Surg Am 99:2011–2018PubMed

38.

Grammatopoulos G, Bolduc ME, Atkins BL, Kendrick BJL, McLardy-Smith P, Murray DW et al (2017) Functional outcome of debridement, antibiotics and implant retention in periprosthetic joint infection involving the hip: a case-control study. Bone Joint J 99:614–622PubMed

39.

Sukeik M, Patel S, Haddad FS (2012) Aggressive early debridement for treatment of acutely infected cemented total hip arthroplasty. Clin Orthop Relat Res 470:3164–3170PubMedPubMedCentral

40.

Tsang SJ, Ting J, Simpson AHRW, Gaston P (2017) Outcomes following debridement, antibiotics and implant retention in the management of periprosthetic infections of the hip: a review of cohort studies. Bone Joint J 99:1458–1466PubMed

41.

Van Kleumen JP, Knox D, Garino JP, Lee GC (2010) Irrigation and debridement and prosthesis retention for treating acute periprosthetic infections. Clin Orthop Relat Res 468:2024–2028

42.

The Lancet (2010) Chinese doctors are under threat. Lancet 376:657

43.

Bradbury T, Fehring TK, Taunton M, Hanssen A, Azzam K, Parvizi J et al (2009) The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of component. J Arthroplast 24:101–104

44.

Lora-Tamayo J, Murillo O, Iribarren JA, Soriano A, Sanchez-Somolinos M, Baraia-Etxaburu JM et al (2013) A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention. Clin Infect Dis 56:182–194PubMed

45.

Zurcher-Pfund L, Uckay I, Legout L, Gamulin A, Vaudaux P, Peter R (2013) Pathogen-driven decision for implant retention in the management of infected total knee prostheses. Int Orthop 37:1471–1475PubMedPubMedCentral

Titel: Partial implant retention in two-stage exchange for chronic infected total hip arthroplasty
verfasst von: Xiaojun Shi
Jing Yang
Zongke Zhou
Bin Shen
Pengde Kang
Fuxing Pei
Publikationsdatum: 04.01.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 3/2020
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-019-04473-0

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Partial implant retention in two-stage exchange for chronic infected total hip arthroplasty