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Fate of Two-Stage Reimplantation After Failed Irrigation and Debridement for Periprosthetic Hip Infection
BACKGROUND: Irrigation and debridement is an attractive treatment option for acute perioperative and acute hematogenous periprosthetic hip infections. We ask the following questions: (1) What are the results of a two-stage reimplantation if preceded by debridement, antibiotics, and implant retention...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772452/ https://www.ncbi.nlm.nih.gov/pubmed/33385033 http://dx.doi.org/10.1016/j.artd.2020.07.009 |
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author | Kavolus, Joseph J. Cunningham, Daniel J. Eftekhary, Nima Ting, Nicholas T. Griffin, William L. Fehring, Thomas K. |
author_facet | Kavolus, Joseph J. Cunningham, Daniel J. Eftekhary, Nima Ting, Nicholas T. Griffin, William L. Fehring, Thomas K. |
author_sort | Kavolus, Joseph J. |
collection | PubMed |
description | BACKGROUND: Irrigation and debridement is an attractive treatment option for acute perioperative and acute hematogenous periprosthetic hip infections. We ask the following questions: (1) What are the results of a two-stage reimplantation if preceded by debridement, antibiotics, and implant retention (DAIR) compared with two-stage reimplantation without an antecedent DAIR? and (2) Do McPherson Musculoskeletal Infection Society (MSIS) host criteria influence results? METHODS: A total of 114 patients were treated with two-stage exchange for periprosthetic hip infection. Sixty-five patients were treated initially with a two-stage exchange, whereas 49 patients underwent an antecedent DAIR before a two-stage exchange. Patients were classified based on MSIS host criteria. Demographics demonstrated homogeneity between cohorts. Failure was defined as return to the operating room for infection, draining sinus, or systemic infection. RESULTS: Treatment failure occurred in 42.9% (21 of 49) of patients treated with an antecedent DAIR. In contrast, treatment failure occurred in only 12.3% (8 of 65) of two-stage only procedures (P < .001). Relative risk of return to the operating room after a two-stage reimplantation with an antecedent DAIR compared with initial resection was 4.52 (95% confidence interval: 1.71, 11.9). MSIS host grading was similar between groups and did not influence the rate of failure in a regression model. The DAIR cohort was also found to consume more resources in terms of hospitalization length and operative procedures (P < .001). CONCLUSIONS: Two-stage exchange procedures for prosthetic hip infections have a higher failure rate and consume more health-care resources when preceded by a failed DAIR. Surgeons and patients should be aware that a failed DAIR may compromise the results of future two-stage procedures. |
format | Online Article Text |
id | pubmed-7772452 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-77724522020-12-30 Fate of Two-Stage Reimplantation After Failed Irrigation and Debridement for Periprosthetic Hip Infection Kavolus, Joseph J. Cunningham, Daniel J. Eftekhary, Nima Ting, Nicholas T. Griffin, William L. Fehring, Thomas K. Arthroplast Today Original Research BACKGROUND: Irrigation and debridement is an attractive treatment option for acute perioperative and acute hematogenous periprosthetic hip infections. We ask the following questions: (1) What are the results of a two-stage reimplantation if preceded by debridement, antibiotics, and implant retention (DAIR) compared with two-stage reimplantation without an antecedent DAIR? and (2) Do McPherson Musculoskeletal Infection Society (MSIS) host criteria influence results? METHODS: A total of 114 patients were treated with two-stage exchange for periprosthetic hip infection. Sixty-five patients were treated initially with a two-stage exchange, whereas 49 patients underwent an antecedent DAIR before a two-stage exchange. Patients were classified based on MSIS host criteria. Demographics demonstrated homogeneity between cohorts. Failure was defined as return to the operating room for infection, draining sinus, or systemic infection. RESULTS: Treatment failure occurred in 42.9% (21 of 49) of patients treated with an antecedent DAIR. In contrast, treatment failure occurred in only 12.3% (8 of 65) of two-stage only procedures (P < .001). Relative risk of return to the operating room after a two-stage reimplantation with an antecedent DAIR compared with initial resection was 4.52 (95% confidence interval: 1.71, 11.9). MSIS host grading was similar between groups and did not influence the rate of failure in a regression model. The DAIR cohort was also found to consume more resources in terms of hospitalization length and operative procedures (P < .001). CONCLUSIONS: Two-stage exchange procedures for prosthetic hip infections have a higher failure rate and consume more health-care resources when preceded by a failed DAIR. Surgeons and patients should be aware that a failed DAIR may compromise the results of future two-stage procedures. Elsevier 2020-09-06 /pmc/articles/PMC7772452/ /pubmed/33385033 http://dx.doi.org/10.1016/j.artd.2020.07.009 Text en © 2020 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Research Kavolus, Joseph J. Cunningham, Daniel J. Eftekhary, Nima Ting, Nicholas T. Griffin, William L. Fehring, Thomas K. Fate of Two-Stage Reimplantation After Failed Irrigation and Debridement for Periprosthetic Hip Infection |
title | Fate of Two-Stage Reimplantation After Failed Irrigation and Debridement for Periprosthetic Hip Infection |
title_full | Fate of Two-Stage Reimplantation After Failed Irrigation and Debridement for Periprosthetic Hip Infection |
title_fullStr | Fate of Two-Stage Reimplantation After Failed Irrigation and Debridement for Periprosthetic Hip Infection |
title_full_unstemmed | Fate of Two-Stage Reimplantation After Failed Irrigation and Debridement for Periprosthetic Hip Infection |
title_short | Fate of Two-Stage Reimplantation After Failed Irrigation and Debridement for Periprosthetic Hip Infection |
title_sort | fate of two-stage reimplantation after failed irrigation and debridement for periprosthetic hip infection |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772452/ https://www.ncbi.nlm.nih.gov/pubmed/33385033 http://dx.doi.org/10.1016/j.artd.2020.07.009 |
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