Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2015; 6(9): 712-718
Published online Oct 18, 2015. doi: 10.5312/wjo.v6.i9.712
Is two-stage reimplantation effective for virulent pathogenic infection in a periprosthetic hip? A retrospective analysis
Yong-Cheol Yoon, Devendra Lakhotia, Jong-Keon Oh, Jun Gyu Moon, Kumar Prashant, Won Yong Shon
Yong-Cheol Yoon, Orthopedic Trauma Division, Gachon University Gil Hospital, Incheon 405-760, South Korea
Devendra Lakhotia, Jong-Keon Oh, Jun Gyu Moon, Kumar Prashant, Won Yong Shon, Department of Orthopedic Surgery, Korea University College of Medicine, Guro Hospital, Seoul 152-703, South Korea
Author contributions: Yoon YC contributed to study design, data collection, data analysis, radiograph analysis, manuscript writing; Lakhotia D contributed to data analysis, radiograph analysis and manuscript writing; Oh JK, Moon JG and Prashant K contributed to data collection and data analysis; Shon WY contributed to performance of surgeries, study design, data analysis, radiograph analysis and manuscript writing.
Institutional review board statement: Our retrospective study contained data from medical records only and thus was conducted without IRB approval (a process requiring approximately 2 mo at our university).
Informed consent statement: Our retrospective study contained data from medical records.
Conflict-of-interest statement: The authors declare that they have no conflict of interest. No benefits in any form have been received or will be received from any commercial party related directly or indirectly to the subject of this article.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author, Dr. Won Yong Shon, at shonwy@hotmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Won Yong Shon, MD, PhD, Professor, Department of Orthopedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul 152-703, South Korea. shonwy@hotmail.com
Telephone: +82-2-26261163
Received: February 12, 2015
Peer-review started: February 13, 2015
First decision: June 9, 2015
Revised: July 27, 2015
Accepted: August 13, 2015
Article in press: August 14, 2015
Published online: October 18, 2015
Processing time: 249 Days and 19 Hours
Abstract

AIM: To investigate the effectiveness of two-stage reimplantation using antibiotic-loaded bone cement (ALBC) and the risk factors associated with failure to control periprosthetic joint infection (PJI).

METHODS: We retrospectively reviewed 38 consecutive hips managed using two-stage reimplantation with ALBC. The mean follow-up period was 5.4 years (range: 2.5-9 years).

RESULTS: The causative pathogens were isolated from 29 patients (76%), 26 of whom were infected with highly virulent organisms. Sixteen patients (42%) underwent at least two first-stage debridements. An increased debridement frequency correlated significantly with high comorbidity (P < 0.001), a lower preoperative Harris hip score (HHS; P < 0.001), antimicrobial resistance, and gram-negative and polymicrobial infection (P = 0.002). Of the 35 patients who underwent two-stage reimplantation, 34 showed no signs of recurrence of infection. The mean HHS improved from 46 ± 12.64 to 78 ± 10.55 points, with 7 (20%), 12 (34%), 11 (32%) and 5 (14%) patients receiving excellent, good, fair and poor ratings, respectively.

CONCLUSION: The current study demonstrated that two-stage reimplantation could successfully treat PJI after hip arthroplasty. However, the ability of ALBC to eradicate infection was limited because frequent debridement was required in high-risk patients (i.e., patients who are either in poor general health due to associated comorbidities or harbor infections due to highly virulent, difficult-to-treat organisms). Level of evidence: Level IV.

Keywords: Two-stage reimplantation; Periprosthetic infection; Antibiotic-loaded bone cement; Debridement

Core tip: Two-stage revision with antibiotic-laden bone cement for periprosthetic infection after total hip arthroplasty is generally recognized as the gold-standard treatment. Two-stage revision usually comprises removal of all components, including cement, and radical debridement of all suspected infectious, necrotic tissues and bone. However, despite the success of two-stage revision for the treatment of infected primary hip arthroplasties, not all causative organisms can be successfully eradicated, especially multidrug-resistant virulent microorganisms; therefore we evaluated the efficacy of two-stage reimplantation with antibiotic-laden bone cement against difficult-to-treat microorganisms as well as the risk factors associated with failure to control infection.