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Archives of Orthopaedic and Trauma Surgery

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01-02-2020 | Joint Infection | Hip Arthroplasty

The direct anterior approach: treating periprosthetic joint infection of the hip using two-stage revision arthroplasty

Authors: Martin Thaler, Ricarda Lechner, Dietmar Dammerer, Hermann Leitner, Ismail Khosravi, Michael Nogler

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2020

Abstract

Background

Either one- or two-stage revision arthroplasties can be used for the treatment of chronic periprosthetic joint infection (PJI) after total hip arthroplasty (THA). We report our results following two-stage revision surgery performed through the direct anterior approach (DAA) interval using a custom-made articulating spacer.

Methods

Between 2009 and 2014, 49 patients (49 consecutive procedures) had surgery through either a DAA or extended DAA approach. Each patient received perioperative intravenous administration of antibiotics. A custom-made spacer was implanted after explanting cup and stem and following extensive debridement. Broad-spectrum antibiotics were administered during the immediate perioperative period and then adjusted according to the infecting organism. Complication rates and eradication rates were observed. WOMAC patient assessments were administered preoperatively and one-year postoperatively.

Results

Of the 49 study patients, five had a recurrence of the infection after the second-stage revision, five had a proximal periprosthetic fracture during the first stage procedure and one patient had a transient femoral nerve palsy that resolved fully within the first postoperative year. 30 different microorganisms were identified on intraoperative specimens. The average time between first and second stage procedure was 65.7 days (range 21–132 days). Eradication of infection was defined as healed wound without fistula, no drainage, no recurrence of the infection, no subsequent surgical intervention for persistent or perioperative infection after second stage revision and no long-term (> 6 months) antimicrobial suppression therapy. Eradication rate of infection in our study was 89.8%. Postoperative WOMAC scores improved significantly

Conclusion

The preliminary clinical results for the custom-made spacer technique implanted through the DAA are promising. Therefore, we believe the DAA can be used safely as a standard operative approach for two-stage revision procedures.

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Title: The direct anterior approach: treating periprosthetic joint infection of the hip using two-stage revision arthroplasty
Authors: Martin Thaler
Ricarda Lechner
Dietmar Dammerer
Hermann Leitner
Ismail Khosravi
Michael Nogler
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Joint Infection
Hip-TEP
Hip-TEP
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03317-1

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The direct anterior approach: treating periprosthetic joint infection of the hip using two-stage revision arthroplasty

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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