Clinical outcome of massive endoprostheses used for managing periprosthetic joint infections of the hip and knee
<h4>Background</h4> <p>Endoprosthetic replacement (EPR) is an option for management of massive bone loss resulting from infection around failed lower limb implants. The aim of this study is to determine the midterm outcome of EPRs performed in the treatment of periprosthetic joint...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2017
|
| _version_ | 1797064957645291520 |
|---|---|
| author | Alvand, A Grammatopoulos, G de Vos, F Scarborough, M Kendrick, B Price, A Gundle, R Whitwell, D Jackson, W Taylor, A Gibbons, C |
| author_facet | Alvand, A Grammatopoulos, G de Vos, F Scarborough, M Kendrick, B Price, A Gundle, R Whitwell, D Jackson, W Taylor, A Gibbons, C |
| author_sort | Alvand, A |
| collection | OXFORD |
| description | <h4>Background</h4> <p>Endoprosthetic replacement (EPR) is an option for management of massive bone loss resulting from infection around failed lower limb implants. The aim of this study is to determine the midterm outcome of EPRs performed in the treatment of periprosthetic joint infection (PJI) and infected failed osteosyntheses around the hip and knee joint and identify factors that influence it.</p> <h4>Methods</h4> <p>We retrospectively reviewed all hip and knee EPRs performed between 2007 and 2014 for the management of chronic infection following complex arthroplasty or fracture fixation. Data recorded included indication for EPR, number of previous surgeries, comorbidities, and organism identified. Outcome measures included PJI eradication rate, complications, implant survival, mortality, and functional outcome (Oxford Hip or Knee Score).</p> <h4>Results</h4> <p>Sixty-nine EPRs (29 knees and 40 hips) were performed with a mean age of 68 years (43-92). Polymicrobial growth was detected in 36% of cases, followed by coagulase-negative staphylococci (28%) and Staphylococcus aureus (10%). Recurrence of infection occurred in 19 patients (28%): 5 were treated with irrigation and debridement, 5 with revision, 1 with above-knee amputation, and 8 remain on longterm antibiotics. PJI eradication was achieved in 50 patients (72%); the chance of PJI eradication was greater in hips (83%) than in knees (59%) (P ¼ .038). The 5-year implant survivorship was 81% (95% confidence interval 74-88). The mean Oxford Hip Score and Oxford Knee Score were 22 (4-39) and 21 (6-43), respectively.</p> <h4>Conclusion</h4> <p>This study supports the use of EPRs for eradication of PJI in complex, multiply revised cases. We describe PJI eradication rate of 72% with acceptable functional outcome.</p> |
| first_indexed | 2024-03-06T21:21:45Z |
| format | Journal article |
| id | oxford-uuid:41acfa58-d950-4234-92f9-91a281339c5b |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T21:21:45Z |
| publishDate | 2017 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:41acfa58-d950-4234-92f9-91a281339c5b2022-03-26T14:45:08ZClinical outcome of massive endoprostheses used for managing periprosthetic joint infections of the hip and kneeJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:41acfa58-d950-4234-92f9-91a281339c5bEnglishSymplectic Elements at OxfordElsevier2017Alvand, AGrammatopoulos, Gde Vos, FScarborough, MKendrick, BPrice, AGundle, RWhitwell, DJackson, WTaylor, AGibbons, C <h4>Background</h4> <p>Endoprosthetic replacement (EPR) is an option for management of massive bone loss resulting from infection around failed lower limb implants. The aim of this study is to determine the midterm outcome of EPRs performed in the treatment of periprosthetic joint infection (PJI) and infected failed osteosyntheses around the hip and knee joint and identify factors that influence it.</p> <h4>Methods</h4> <p>We retrospectively reviewed all hip and knee EPRs performed between 2007 and 2014 for the management of chronic infection following complex arthroplasty or fracture fixation. Data recorded included indication for EPR, number of previous surgeries, comorbidities, and organism identified. Outcome measures included PJI eradication rate, complications, implant survival, mortality, and functional outcome (Oxford Hip or Knee Score).</p> <h4>Results</h4> <p>Sixty-nine EPRs (29 knees and 40 hips) were performed with a mean age of 68 years (43-92). Polymicrobial growth was detected in 36% of cases, followed by coagulase-negative staphylococci (28%) and Staphylococcus aureus (10%). Recurrence of infection occurred in 19 patients (28%): 5 were treated with irrigation and debridement, 5 with revision, 1 with above-knee amputation, and 8 remain on longterm antibiotics. PJI eradication was achieved in 50 patients (72%); the chance of PJI eradication was greater in hips (83%) than in knees (59%) (P ¼ .038). The 5-year implant survivorship was 81% (95% confidence interval 74-88). The mean Oxford Hip Score and Oxford Knee Score were 22 (4-39) and 21 (6-43), respectively.</p> <h4>Conclusion</h4> <p>This study supports the use of EPRs for eradication of PJI in complex, multiply revised cases. We describe PJI eradication rate of 72% with acceptable functional outcome.</p> |
| spellingShingle | Alvand, A Grammatopoulos, G de Vos, F Scarborough, M Kendrick, B Price, A Gundle, R Whitwell, D Jackson, W Taylor, A Gibbons, C Clinical outcome of massive endoprostheses used for managing periprosthetic joint infections of the hip and knee |
| title | Clinical outcome of massive endoprostheses used for managing periprosthetic joint infections of the hip and knee |
| title_full | Clinical outcome of massive endoprostheses used for managing periprosthetic joint infections of the hip and knee |
| title_fullStr | Clinical outcome of massive endoprostheses used for managing periprosthetic joint infections of the hip and knee |
| title_full_unstemmed | Clinical outcome of massive endoprostheses used for managing periprosthetic joint infections of the hip and knee |
| title_short | Clinical outcome of massive endoprostheses used for managing periprosthetic joint infections of the hip and knee |
| title_sort | clinical outcome of massive endoprostheses used for managing periprosthetic joint infections of the hip and knee |
| work_keys_str_mv | AT alvanda clinicaloutcomeofmassiveendoprosthesesusedformanagingperiprostheticjointinfectionsofthehipandknee AT grammatopoulosg clinicaloutcomeofmassiveendoprosthesesusedformanagingperiprostheticjointinfectionsofthehipandknee AT devosf clinicaloutcomeofmassiveendoprosthesesusedformanagingperiprostheticjointinfectionsofthehipandknee AT scarboroughm clinicaloutcomeofmassiveendoprosthesesusedformanagingperiprostheticjointinfectionsofthehipandknee AT kendrickb clinicaloutcomeofmassiveendoprosthesesusedformanagingperiprostheticjointinfectionsofthehipandknee AT pricea clinicaloutcomeofmassiveendoprosthesesusedformanagingperiprostheticjointinfectionsofthehipandknee AT gundler clinicaloutcomeofmassiveendoprosthesesusedformanagingperiprostheticjointinfectionsofthehipandknee AT whitwelld clinicaloutcomeofmassiveendoprosthesesusedformanagingperiprostheticjointinfectionsofthehipandknee AT jacksonw clinicaloutcomeofmassiveendoprosthesesusedformanagingperiprostheticjointinfectionsofthehipandknee AT taylora clinicaloutcomeofmassiveendoprosthesesusedformanagingperiprostheticjointinfectionsofthehipandknee AT gibbonsc clinicaloutcomeofmassiveendoprosthesesusedformanagingperiprostheticjointinfectionsofthehipandknee |