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

Clauss, Martin; Hunkeler, Christof; Manzoni, Isabella; Sendi, Parham (2020). Debridement, Antibiotics and Implant Retention for Hip Periprosthetic Joint Infection: Analysis of Implant Survival after Cure of Infection. Journal of bone and joint infection, 5(1), pp. 35-42. Ivyspring International Publisher 10.7150/jbji.40924

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases

UniBE Contributor:

Sendi, Parham

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

2206-3552

Publisher:

Ivyspring International Publisher

Language:

English

Submitter:

Parham Sendi

Date Deposited:

14 Aug 2020 16:24

Last Modified:

16 Aug 2020 03:44

Publisher DOI:

10.7150/jbji.40924

PubMed ID:

32117688

BORIS DOI:

10.7892/boris.145934

URI:

https://boris.unibe.ch/id/eprint/145934

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