Berend, Clin Orthop Relat Res 2013 - Two-Stage Treatment of Hip Periprosthetic Joint Infection Is Associated with a High Rate of Infection Control but High Mortality - Article Summary

Two-Stage Treatment of Hip Periprosthetic Joint Infection Is Associated with a High Rate of Infection Control but High Mortality

Berend, Sneller, et al.·Clin Orthop Relat Res·2013·372 citations·Retrospective cohort

Background

Periprosthetic infection after total hip arthroplasty (THA) is a devastating complication. Reported rates of infection control range from 80% to 95% but mortality rates associated with treatment of infected THA are also substantial and we suspect underreported.

Purpose

For patients selected for two-stage treatment of infected THA we therefore determined (1) mortality; (2) rate of reimplantation; and (3) rate of reinfection.

Methods

We identified 202 patients (205 hips) with infected primary or revision THA treated with a 2-stage protocol between 1996 and 2009 in our prospectively collected practice registry.
Patients underwent 2-stage treatment for infection, including removal of all implants and foreign material with implantation of an antibiotic-laden cement spacer in the first stage followed by intravenous culture-specific antibiotics for a minimum of 6 weeks.
Second-stage reimplantation was performed if erythrocyte sedimentation rate and C-reactive protein were trending toward normal and the wound was well healed.
13 patients (13 hips) were lost to followup before 24 months.
The minimum followup in surviving patients was 24 months or failure (average, 53 months; range, 24-180 months).

Results

14 patients (7%; 14 hips) died before reimplantation and 2 were not candidates because of medical comorbidities.
The 90-day mortality rate after the first-stage débridement was 4% (8 patients).
Of the 186 patients (189 hips) who underwent reimplantation, 157 (83%) achieved control of the infection.
Including all patients who underwent the first stage, survival and infection control after 2-stage reimplantation was 76%.

Conclusions

Two-stage treatment of deep infection in primary and revision THA is associated with substantial mortality and a substantial failure rate from both reinfection and inability to perform the second stage.

Level of evidence: Level IV, therapeutic study. Copyright remains with the authors and publisher.

Supplemental

Two-Stage Treatment of Hip Periprosthetic Joint Infection Is Associated with a High Rate of Infection Control but High Mortality.

Berend, Sneller, et al.Clin Orthop Relat Res2013372 citationsRetrospective cohort