Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Vielgut, I.
Clinical outcome and microbiological findings using antibiotic loaded spacers in two-stage revision of periprosthetic hip and knee joint infections
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2017. pp.
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- Autor*innen der Med Uni Graz:
- Vielgut Ines
- Betreuer*innen:
- Glehr Mathias
- Leithner Andreas
- Altmetrics:
- Abstract:
- Background: Total knee- and hip arthroplasty (TKA, THA) are considered to be successful treatment strategies for osteoarthritis of the knee- and hip joint. However, the constantly increasing number of joint replacements is accompanied by a rising number of prosthetic joint infections (PJI) as well. With a reported incidence of less than one percent after primary hip- and less than two percent after primary knee replacement - and a considerable higher rate after revision surgery - PJI represents one of the leading causes for revision following total joint arthroplasty of the lower extremity. Therefore, the management of PJI remains a challenging task, as adequate treatment strategies seem to be mandatory to avoid irreversible damage of the affected joint or further systemic complications. Two-stage revision arthroplasty, including implant-removal and the implantation of an antibiotic-loaded cement spacer, followed by revision arthroplasty later on, seems to be the procedure of choice in cases of PJI, especially for late, chronic infections. Although this procedure is well described in the literature, the results remain unpredictable due to various clinical findings and the absence of prospective randomised trials. We analysed (1) mortality and (2) reinfection rates in a series of patients who underwent two-stage revision surgery for periprosthetic hip- and knee joint infections. Furthermore, we maintained a special focus on the (3) length of spacer-retention and its impact on the outcome in order to determine the optimal time for second-stage surgery. Patients and Methods: A consecutive series of 76 patients with periprosthetic hip- and 77 patients with periprosthetic knee joint infections, who had undergone two-stage revision arthroplasty for PJI between 2005 and 2013, were included into the study. Classification of infection was performed according to the system developed by the Workgroup of the Musculoskeletal Infection Society. Antibiotic loaded cement spacers were used for all of the patients. Results: The mean spacer-retention period was 12.6 weeks for prosthetic hip- and 10.6 weeks for prosthetic knee joint infections. One or more additional spacer exchanges were necessary in 13 (9.9%) and 17 (22.3%) cases due to positive signs of persisting infection in the frozen section and suspect intra-operative findings. After a mean overall follow-up time of 20.5 and 35 months, PJI has reoccurred in 19 (30.3 %) versus 14 (18.7%) patients. For PJI of the hip, spacer-retention periods of more than eleven or less than 4 weeks have led to a significant worse outcome. The best outcome was achieved in patients who had undergone second-stage surgery after 4-11 weeks. 90% of these patients remained free of infection until final follow-up. For prosthetic knee joint infections, it could be proven that a prolonged spacer-retention period of more than 83 days has led to a significant higher proportion of reinfections. Furthermore, it could be seen that significant compromising local conditions of the periprosthetic tissue and surrounding skin, as well as repeated spacer-exchanges between the first- and second-stage procedure, have influenced the outcome negatively. No significant influence on the outcome regarding re-infection rates could be determined for patients’ age or gender. Conclusions: According to our findings, the optimal time for second-stage procedure could be calculated between four and eleven weeks for hip joint infections and less than 12 weeks for PJI of the knee. To our knowledge, this study is the first focusing on the length of spacer retention and its potential impact on the outcome within the setting of two-stage revision arthroplasty for PJI. Nonetheless, given the clinical significance and the expected increase of PJI in the nearer future, further, essentially prospective studies would be desirable.