A Treatment Pathway Variation for Chronic Prosthesis-Associated Infections

Periprosthetic joint infections (PJIs) are relatively rare but are on the rise because of the increasing total number of implantations performed. Treatment of PJI remains individualized and involves both surgical and medical treatment, with variations depending on the time of implantation, the duration and severity of the infection, tissue damage, and the underlying microorganism. In this case series study, we investigated clinical and functional outcomes of a variation of the Liestal algorithm in patients with PJI following total hip arthroplasty. METHODS: This study included 32 patients (33 cases) who were treated for chronic PJI with 2-stage exchange using a cement spacer during the period of 2003 to 2014. In contrast to other treatment pathways, antibiotic therapy was targeted to the causative microorganism as early as possible despite the presence of a cement spacer. Second-look surgery was performed 4 days after removal of the primary implant and a 4-week antibiotic-free window was interposed before definitive reimplantation. Thereafter, antibiotic treatment continued for approximately 6 weeks. All patients were followed for a minimum of 2 years. Parameters investigated were the duration of infection-free survival, functional outcome, and epidemiological data. RESULTS: At 2 years of follow-up and at the most recent follow-up (on average, 7 years after reimplantation), 100% of the patients were free of signs of infection, and the mean Harris hip score (HHS) was 89 at the latest follow-up. CONCLUSIONS: A meticulously performed 2-stage exchange for PJI with early targeted antibiotic treatment, second-look surgery, an antibiotic-free window before reimplantation, and antibiotic treatment post-reimplantation of medium duration is associated with excellent infection-related and good functional outcome after ≥2 years of follow-up even in cases of chronic PJI. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.