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01-06-2015 | Original Paper

Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome

Authors: Georgios K. Triantafyllopoulos, Lazaros A. Poultsides, Vasileios I. Sakellariou, Wei Zhang, Peter K. Sculco, Yan Ma, Thomas P. Sculco

Published in: International Orthopaedics | Issue 6/2015

Abstract

Purpose

Our purpose was to identify the success rate and factors predicting outcome of irrigation and debridement (I&D) in patients with deep periprosthetic joint infection (PJI) of the hip.

Methods

We retrospectively reviewed clinical characteristics of patients with deep PJI after primary/revision total hip arthroplasty (THA) between January 2000 and May 2013 treated with I&D. Implant retention was the outcome of interest. Sixty patients (29 men and 31 women; mean age 64.9 years) were identified. Mean follow-up was 59 months (range, 12–168).

Results

The implants were retained in 42 patients (70%). Failure of I&D treatment correlated with duration of symptoms >five days (p <0.001) and obesity [body mass index (BMI) ≥ 30)] (p = 0.0289). Treatment outcome was affected by the type of pathogen (p = 0.0482), with patients with methicillin-resistant staphylococci having significantly lower odds of success.

Conclusions

I&D can be a feasible option in THA patients presenting with acute deep PJI. Duration of symptoms >five days, isolation of methicillin-resistant staphylococci and obesity should be taken into consideration in pre-operative decision making.

Kurtz SM, Ong KL, Lau E, Bozic KJ (2014) Impact of the economic downturn on total joint replacement demand in the united states: Updated projections to 2021. J Bone Joint Surg Am 96:624–630. doi:10.2106/JBJS.M.00285 PubMedCrossRef

Salvati EA, Gonzalez Della Valle A, Masri BA, Duncan CP (2003) The infected total hip arthroplasty. Instr Course Lect 52:223–245PubMed

Poultsides LA, Liaropoulos LL, Malizos KN (2010) The socioeconomic impact of musculoskeletal infections. J Bone Joint Surg Am 92:e13. doi:10.2106/JBJS.I.01131 PubMedCrossRef

Del Pozo JL, Patel R (2009) Clinical practice. infection associated with prosthetic joints. N Engl J Med 361:787–794. doi:10.1056/NEJMcp0905029 PubMedCentralPubMedCrossRef

Azzam KA, Seeley M, Ghanem E, Austin MS, Purtill JJ, Parvizi J (2010) Irrigation and debridement in the management of prosthetic joint infection: traditional indications revisited. J Arthroplasty 25:1022–1027. doi:10.1016/j.arth.2010.01.104 PubMedCrossRef

Barberan J, Aguilar L, Carroquino G, Gimenez MJ, Sanchez B, Martinez D, Prieto J (2006) Conservative treatment of staphylococcal prosthetic joint infections in elderly patients. Am J Med 119:993.e7–993.10. doi:10.1016/j.amjmed.2006.03.036 CrossRef

Buller LT, Sabry FY, Easton RW, Klika AK, Barsoum WK (2012) The preoperative prediction of success following irrigation and debridement with polyethylene exchange for hip and knee prosthetic joint infections. J Arthroplasty 27:857–64.e1-4. doi:10.1016/j.arth.2012.01.003 PubMedCrossRef

Byren I, Bejon P, Atkins BL, Angus B, Masters S, McLardy-Smith P, Gundle R, Berendt A (2009) One hundred and twelve infected arthroplasties treated with 'DAIR' (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother 63:1264–1271. doi:10.1093/jac/dkp107 PubMedCentralPubMedCrossRef

Choi HR, von Knoch F, Kandil AO, Zurakowski D, Moore S, Malchau H (2012) Retention treatment after periprosthetic total hip arthroplasty infection. Int Orthop 36:723–729. doi:10.1007/s00264-011-1324-5 PubMedCentralPubMedCrossRef

10.

Crockarell JR, Hanssen AD, Osmon DR, Morrey BF (1998) Treatment of infection with debridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am 80:1306–1313PubMed

11.

Engesaeter LB, Dale H, Schrama JC, Hallan G, Lie SA (2011) Surgical procedures in the treatment of 784 infected THAs reported to the norwegian arthroplasty register. Acta Orthop 82:530–537. doi:10.3109/17453674.2011.623572 PubMedCentralPubMedCrossRef

12.

Koyonos L, Zmistowski B, Della Valle CJ, Parvizi J (2011) Infection control rate of irrigation and debridement for periprosthetic joint infection. Clin Orthop Relat Res 469:3043–3048. doi:10.1007/s11999-011-1910-2 PubMedCentralPubMedCrossRef

13.

Kuiper JW, Vos SJ, Saouti R, Vergroesen DA, Graat HC, Debets-Ossenkopp YJ, Peters EJ, Nolte PA (2013) Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention): analysis of risk factors and local antibiotic carriers in 91 patients. Acta Orthop 84:380–386. doi:10.3109/17453674.2013.823589 PubMedCentralPubMedCrossRef

14.

Sukeik M, Patel S, Haddad FS (2012) Aggressive early debridement for treatment of acutely infected cemented total hip arthroplasty. Clin Orthop Relat Res 470:3164–3170. doi:10.1007/s11999-012-2500-7 PubMedCentralPubMedCrossRef

15.

Tsukayama DT, Estrada R, Gustilo RB (1996) Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 78:512–523PubMed

16.

Westberg M, Grogaard B, Snorrason F (2012) Early prosthetic joint infections treated with debridement and implant retention: 38 primary hip arthroplasties prospectively recorded and followed for median 4 years. Acta Orthop 83:227–232. doi:10.3109/17453674.2012.678801 PubMedCentralPubMedCrossRef

17.

Fehring TK, Odum SM, Berend KR, Jiranek WA, Parvizi J, Bozic KJ, Della Valle CJ, Gioe TJ (2013) Failure of irrigation and debridement for early postoperative periprosthetic infection. Clin Orthop Relat Res 471:250–257. doi:10.1007/s11999-012-2373-9 PubMedCentralPubMedCrossRef

18.

Klouche S, Lhotellier L, Mamoudy P (2011) Infected total hip arthroplasty treated by an irrigation-debridement/component retention protocol. a prospective study in a 12-case series with minimum 2 years' follow-up. Orthop Traumatol Surg Res 97:134–138. doi:10.1016/j.otsr.2011.01.002 PubMedCrossRef

19.

Geurts JA, Janssen DM, Kessels AG, Walenkamp GH (2013) Good results in postoperative and hematogenous deep infections of 89 stable total hip and knee replacements with retention of prosthesis and local antibiotics. Acta Orthop. doi:10.3109/17453674.2013.858288 PubMedCentralPubMed

20.

Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG (2011) New definition for periprosthetic joint infection: from the workgroup of the musculoskeletal infection society. Clin Orthop Relat Res 469:2992–2994. doi:10.1007/s11999-011-2102-9 PubMedCentralPubMedCrossRef

21.

Wolf M, Clar H, Friesenbichler J, Schwantzer G, Bernhardt G, Gruber G, Glehr M, Leithner A, Sadoghi P (2014) Prosthetic joint infection following total hip replacement: results of one-stage versus two-stage exchange. Int Orthop 38:1363–1368. doi:10.1007/s00264-014-2309-y PubMedCrossRef

22.

Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 95-B:1450–1452. doi:10.1302/0301-620X.95B11.33135 PubMedCrossRef

23.

Konigsberg BS, Valle CJ, Ting NT, Qiu F, Sporer SM (2013) Acute hematogenous infection following total hip and knee arthroplasty. J Arthroplasty. doi:10.1016/j.arth.2013.07.021 PubMed

24.

Betz M, Abrassart S, Vaudaux P, Gjika E, Schindler M, Billieres J, Zenelaj B, Suva D, Peter R, Uckay I (2015) Increased risk of joint failure in hip prostheses infected with staphylococcus aureus treated with debridement, antibiotics and implant retention compared to streptococcus. Int Orthop 39:397–401. doi:10.1007/s00264-014-2510-z PubMedCrossRef

25.

Namba RS, Paxton L, Fithian DC, Stone ML (2005) Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty 20:46–50PubMedCrossRef

26.

Bozic KJ, Ries MD (2005) The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am 87:1746–1751. doi:10.2106/JBJS.D.02937 PubMedCrossRef

27.

Cierny G 3rd, DiPasquale D (2002) Periprosthetic total joint infections: staging, treatment, and outcomes. Clin Orthop Relat Res 403:23–28PubMedCrossRef

28.

Guerado E, Cano JR, Cruz E, Bertrand ML, Hirschfeld M, Benitez-Parejo N (2015) Should hip fractures be operated upon only by specialist hip unit surgeons in order to lower rates of surgical site infection? Int Orthop 39:105–110. doi:10.1007/s00264-014-2543-3 PubMedCrossRef

29.

Maoz G, Phillips M, Bosco J, Slover J, Stachel A, Inneh I, Iorio R (2014) The otto aufranc award: Modifiable versus nonmodifiable risk factors for infection after hip arthroplasty. Clin Orthop Relat Res. doi:10.1007/s11999-014-3780-x

Title: Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome
Authors: Georgios K. Triantafyllopoulos
Lazaros A. Poultsides
Vasileios I. Sakellariou
Wei Zhang
Peter K. Sculco
Yan Ma
Thomas P. Sculco
Publication date: 01-06-2015
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 6/2015
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-015-2753-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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