Removal of an Infected Total Hip Arthroplasty: Risk Factors for Repeat Debridement, Long-term Spacer Retention, and Mortality

Abstract

Background: Two-stage exchange arthroplasty remains the preferred approach to treatment of chronic periprosthetic joint infection (PJI) following total hip arthroplasty (THA). The objective of the present study is to investigate the fate of antibiotic spacers placed for periprosthetic joint infection after THA and evaluate risk factors for outcomes other than reimplantation.

Methods: A national database was queried for Medicare patients who underwent removal of an infected hip prosthesis and placement of an antibiotic spacer. Patients with a study end point within 1 year postoperatively were included: (1) in-hospital mortality, (2) repeat debridement without reimplantation within 1 year, (3) resection arthroplasty, and (4) reimplantation of a hip arthroplasty. Independent patient-related risk factors for these end points were evaluated with a multivariate logistic regression analysis.

Results: A total of 7146 patients met all inclusion and exclusion criteria. Within 1 year postoperatively, 464 patients (6.5%) died in a hospital setting, 775 patients (10.8%) had a repeat debridement procedure, 404 patients (5.7%) had a resection arthroplasty, 1202 patients (16.8%) retained their spacers, and the remaining 4301 patients (60.2%) were reimplanted at an average of 124.4 ± 39.3 days. Numerous independent patient-related risk factors for these were identified.

Conclusion: At 1 year only 60% of patients undergo reimplantation. One-sixth of patients retain their spacer and approximately 10% require repeat debridement. Death occurred in at least 6% of the population. Several independent patient-related risk factors exist for repeat debridement, no reimplantation or death within 1 year following index THA removal.

Keywords: debridement; infection; mortality; revision; spacer; total hip arthroplasty.