High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange
Abstract Background Two-stage exchange arthroplasty is still the preferred treatment choice for chronic PJI. However, the results remain unpredictable. We analyzed the treatment success of patients with an infected hip prosthesis, who were treated according to a standardized algorithm with a multidi...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-03-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | http://link.springer.com/article/10.1186/s13018-019-1122-0 |
| _version_ | 1817996878063599616 |
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| author | Doruk Akgün Michael Müller Carsten Perka Tobias Winkler |
| author_facet | Doruk Akgün Michael Müller Carsten Perka Tobias Winkler |
| author_sort | Doruk Akgün |
| collection | DOAJ |
| description | Abstract Background Two-stage exchange arthroplasty is still the preferred treatment choice for chronic PJI. However, the results remain unpredictable. We analyzed the treatment success of patients with an infected hip prosthesis, who were treated according to a standardized algorithm with a multidisciplinary team approach and evaluated with a strict definition of failure. Methods In this single-center prospective cohort study, all hip PJI episodes from March 2013 to May 2015 were included. Treatment failure was assessed according to the Delphi-based consensus definition. The Kaplan-Meier survival method was used to estimate the probability of infection-free survival. Patients were dichotomized into two groups depending on the number of previous septic revisions, duration of prosthesis-free interval, positive culture with difficult-to-treat microorganisms, microbiology at explantation, and microbiology at reimplantation. Results Eighty-four patients with hip PJI were the subject of this study. The most common isolated microorganisms were coagulase-negative staphylococci (CNS) followed by Staphylococcus aureus and Propionibacterium. Almost half of the study cohort (46%) had at least one previous septic revision before admission. The Kaplan-Meier estimated infection-free survival after 3 years was 89.3% (95% CI, 80% to 94%) with 30 patients at risk. The mean follow-up was 33.1 months (range, 24–48 months) with successful treatment of PJI. There were no statistical differences in infect eradication rate among the dichotomized groups. Conclusions High infect eradication rates were achieved in a challenging cohort using a standardized two-stage exchange supported by a multidisciplinary approach. |
| first_indexed | 2024-04-14T02:30:01Z |
| format | Article |
| id | doaj.art-6efdcf539a3e411bb8a62140bed481ae |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-14T02:30:01Z |
| publishDate | 2019-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-6efdcf539a3e411bb8a62140bed481ae2022-12-22T02:17:43ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2019-03-011411810.1186/s13018-019-1122-0High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchangeDoruk Akgün0Michael Müller1Carsten Perka2Tobias Winkler3Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal SurgeryCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal SurgeryCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal SurgeryCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal SurgeryAbstract Background Two-stage exchange arthroplasty is still the preferred treatment choice for chronic PJI. However, the results remain unpredictable. We analyzed the treatment success of patients with an infected hip prosthesis, who were treated according to a standardized algorithm with a multidisciplinary team approach and evaluated with a strict definition of failure. Methods In this single-center prospective cohort study, all hip PJI episodes from March 2013 to May 2015 were included. Treatment failure was assessed according to the Delphi-based consensus definition. The Kaplan-Meier survival method was used to estimate the probability of infection-free survival. Patients were dichotomized into two groups depending on the number of previous septic revisions, duration of prosthesis-free interval, positive culture with difficult-to-treat microorganisms, microbiology at explantation, and microbiology at reimplantation. Results Eighty-four patients with hip PJI were the subject of this study. The most common isolated microorganisms were coagulase-negative staphylococci (CNS) followed by Staphylococcus aureus and Propionibacterium. Almost half of the study cohort (46%) had at least one previous septic revision before admission. The Kaplan-Meier estimated infection-free survival after 3 years was 89.3% (95% CI, 80% to 94%) with 30 patients at risk. The mean follow-up was 33.1 months (range, 24–48 months) with successful treatment of PJI. There were no statistical differences in infect eradication rate among the dichotomized groups. Conclusions High infect eradication rates were achieved in a challenging cohort using a standardized two-stage exchange supported by a multidisciplinary approach.http://link.springer.com/article/10.1186/s13018-019-1122-0HipOutcomePeriprosthetic joint infectionTwo-stage exchange |
| spellingShingle | Doruk Akgün Michael Müller Carsten Perka Tobias Winkler High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange Journal of Orthopaedic Surgery and Research Hip Outcome Periprosthetic joint infection Two-stage exchange |
| title | High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange |
| title_full | High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange |
| title_fullStr | High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange |
| title_full_unstemmed | High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange |
| title_short | High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange |
| title_sort | high cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two stage exchange |
| topic | Hip Outcome Periprosthetic joint infection Two-stage exchange |
| url | http://link.springer.com/article/10.1186/s13018-019-1122-0 |
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