Complications in the treatment of periprosthetic joint infection of the hip: when do they occur?
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Published:2021-07-29
Issue:7
Volume:6
Page:295-303
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ISSN:2206-3552
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Container-title:Journal of Bone and Joint Infection
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language:en
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Short-container-title:J. Bone Joint Infect.
Author:
Li Katherine,Cuadra Mario,Scarola Gregory,Odum Susan,Otero Jesse,Griffin William,Springer Bryan D.
Abstract
Abstract. Prosthetic joint infection (PJI) is a devastating complication after total
hip arthroplasty (THA). The common treatment in the USA is a two-stage
exchange which can be associated with significant morbidity and mortality.
The purpose of this study was to analyze complications in the treatment
course of patients undergoing two-stage exchange for PJI THA and determine
when they occur.
Methods:
We analyzed all patients that underwent two-stage exchange arthroplasty for
treatment of PJI after THA from January 2005 to January 2018 at a single
institution. Complications were categorized as medical or surgical and divided
into interstage and post-reimplantation. Minimum follow-up was 1 year.
Success was based on the MusculoSkeletal Infection Society (MSIS)
definition.
Results:
205 hips (203 patients) underwent first stage of planned two-stage exchange.
The median age was 68 (interquartile range (IQR) 18). There were 97 males and 106 females.
Overall, 73/205 (38 %) patients had at least one complication during
treatment: 13.5 % (25/185) of patients experienced a medical complication
and 28.1 % (52/185) a surgical complication; 2.4 % died within 1 year
of surgery, and 4.9 % (15/203) had mortality at a median of 2.5 years (IQR 4.9); 27 % of patients had complications during the interstage period, most commonly being recurrence of infection requiring additional surgery
(63 %); and 14 % of patients experienced a complication following
reimplantation, most commonly persistence or recurrence of infection
(59 %). While 92 % of patients that initiated treatment were ultimately
reimplanted, only 69 % were infection free at 1 year and required no
additional treatment.
Conclusions:
While two-stage exchanges for PJI in THA have been reported as successful,
there are few reports of the complications during the process. In our
series, significant numbers of patients experienced complications, often
during the interstage period, highlighting the morbidity of this method of
treatment.
Publisher
Copernicus GmbH
Subject
Infectious Diseases,Orthopedics and Sports Medicine,Surgery
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