Journal cover Journal topic
Journal of Bone and Joint Infection An open-access journal of the European Bone and Joint Infection Society and the MusculoSkeletal Infection Society
Journal topic

Journal metrics

h5-index value: 15
h5-index15
Volume 5, issue 1
J. Bone Joint Infect., 5, 35–42, 2020
https://doi.org/10.7150/jbji.40924
© Author(s) 2020. This work is distributed under
the Creative Commons Attribution 4.0 License.
J. Bone Joint Infect., 5, 35–42, 2020
https://doi.org/10.7150/jbji.40924
© Author(s) 2020. This work is distributed under
the Creative Commons Attribution 4.0 License.

Original full-length article 10 Feb 2020

Original full-length article | 10 Feb 2020

Debridement, Antibiotics and Implant Retention for Hip Periprosthetic Joint Infection: Analysis of Implant Survival after Cure of Infection

Martin Clauss1,2, Christof Hunkeler1,3, Isabella Manzoni1, and Parham Sendi2,4,5 Martin Clauss et al.
  • 1Interdisciplinary Septic Surgical Unit, Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
  • 2Center for Muscular-Skeletal Infections, Department of Orthopedics and Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland
  • 3Medical Faculty, University of Basel, Basel, Switzerland
  • 4Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland
  • 5Institute for Infectious Diseases, University of Bern, Bern, Switzerland

Abstract. Background: Debridement, antibiotics and implant retention (DAIR) is a valuable option for treating early and acute periprosthetic joint infection (PJI). The inflammation caused by the infection and the surgical intervention during DAIR may influence the long-term stability of the implant. In this study, we analyzed the sequelae of DAIR on implant survival in hip PJI after cure of infection.

Methods: Total hip arthroplasties (THAs) from our database implanted between 1992 and 2016 were included in a retrospective double-cohort study. THAs were exposed (DAIR cohort) or not exposed to DAIR (control cohort). The control cohort comprised patients matched 3:1 to the DAIR cohort. The outcome was implant failure over time. It was evaluated for (i) revision for any reason, (ii) aseptic loosening of any component, and (iii) radiographic evidence of loosening.

Results: 57 THAs (56 patients) were included in the DAIR cohort and 170 THAs (168 patients) in the control cohort. The mean follow-up periods in the DAIR and control cohorts were 6.1 and 7.8 years, respectively. During follow-up, 20 (36%) patients in the DAIR cohort and 54 (32%) in the control cohort died after a mean of 4.1 and 7.2 years, respectively. Revision for any reason was performed in 9 (16%) THAs in the DAIR cohort and in 10 (6%) THAs (p=0.03) in the control cohort, and revision for aseptic loosening of any component in 5 (9%) and 8 (5%) THAs (p=0.32), respectively. Radiological analysis included 56 THAs in the DAIR cohort and 168 THAs in the control cohort. Two (4%) stems and 2 (4%) cups in the DAIR cohort and 7 (4%) and 1 (0.6%) in the control cohort, respectively, demonstrated radiological signs of failure (p=1).

Conclusions: THAs exposed to DAIR were revised for any reason more frequently than were THAs in the control cohort. The difference was mainly caused by septic failures. After cure of PJI, the difference in revisions for aseptic loosening was not significant. There was no significant difference in radiographic evidence of loosening of any component between cohorts. These data suggest that cured hip PJI previously exposed to DAIR do not fail more frequently for aseptic reasons than do THAs not exposed to DAIR.

Publications Copernicus
Download
Citation