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Archives of Orthopaedic and Trauma Surgery

25-04-2024 | Hip-TEP | Hip Arthroplasty

Validity of a preoperative scoring system for surgical management of periprosthetic hip infection: one-stage vs. two-stage revision

Authors: Kenichi Oe, Hirokazu Iida, Yosuke Otsuki, Takashi Toyoda, Fumito Kobayashi, Shohei Sogawa, Tomohisa Nakamura, Takanori Saito

Published in: Archives of Orthopaedic and Trauma Surgery

Abstract

Introduction

There are no widely accepted algorithms for determining optimal treatment for periprosthetic joint infection (PJI). Our study aimed to confirm the validity of a previously published scoring system in a larger number of patients to support a rational surgical treatment strategy for periprosthetic hip infection.

Materials and methods

Between February 2001 and December 2020, we performed 155 consecutive revision total hip arthroplasties (THAs) for PJI, with mean follow-up of 6 years. One-stage revision THA was performed in 56 hips and two-stage revision THA in 99 hips. Prosthesis survival from recurrent infection was determined by Kaplan-Meier analysis, using implant removal as the endpoint. The pre-operative scoring system (full score of 12 points), including 6 essential elements, was retrospectively evaluated.

Results

The 10-year survival rates were 98% for one-stage (95% confidence interval [CI], 94–100) and 87% (95% CI, 79–96) for two-stage revision THA. Multivariate Cox regression analysis provided a total preoperative score as an independent risk factor for implant removal (hazard ratio, 0.17; 95% CI, 0.06–0.49; p < 0.001). The sensitivity and specificity at the cut-off of 4 points on the scoring system were 80% and 91%, respectively. The average score for one-stage revision THA in successful and failed cases were 8.9 and 6.0, and for two-stage revision THA were 6.5 and 3.9, respectively. We found significant differences between successful cases in one- and two-stage revision THA (p < 0.05).

Conclusions

The preoperative scoring system was useful for managing PJI. One-stage revision THA is recommended in patients scoring ≥ 9 points, and meticulously performed two-stage revision THA is encouraged for patients scoring ≥ 4 points.

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Title: Validity of a preoperative scoring system for surgical management of periprosthetic hip infection: one-stage vs. two-stage revision
Authors: Kenichi Oe
Hirokazu Iida
Yosuke Otsuki
Takashi Toyoda
Fumito Kobayashi
Shohei Sogawa
Tomohisa Nakamura
Takanori Saito
Publication date: 25-04-2024
Publisher: Springer Berlin Heidelberg
Keywords: Hip-TEP
Hip-TEP
Published in: Archives of Orthopaedic and Trauma Surgery
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-024-05279-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Validity of a preoperative scoring system for surgical management of periprosthetic hip infection: one-stage vs. two-stage revision

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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