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Observational Study
. 2019 Mar 13;14(1):78.
doi: 10.1186/s13018-019-1122-0.

High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange

Doruk Akgün  1   2 , Michael Müller  3 , Carsten Perka  3 , Tobias Winkler  3
Affiliations
Observational Study

High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange

Doruk Akgün et al. J Orthop Surg Res. .

Abstract

Background: Two-stage exchange arthroplasty is still the preferred treatment choice for chronic PJI. However, the results remain unpredictable. We analyzed the treatment success of patients with an infected hip prosthesis, who were treated according to a standardized algorithm with a multidisciplinary team approach and evaluated with a strict definition of failure.

Methods: In this single-center prospective cohort study, all hip PJI episodes from March 2013 to May 2015 were included. Treatment failure was assessed according to the Delphi-based consensus definition. The Kaplan-Meier survival method was used to estimate the probability of infection-free survival. Patients were dichotomized into two groups depending on the number of previous septic revisions, duration of prosthesis-free interval, positive culture with difficult-to-treat microorganisms, microbiology at explantation, and microbiology at reimplantation.

Results: Eighty-four patients with hip PJI were the subject of this study. The most common isolated microorganisms were coagulase-negative staphylococci (CNS) followed by Staphylococcus aureus and Propionibacterium. Almost half of the study cohort (46%) had at least one previous septic revision before admission. The Kaplan-Meier estimated infection-free survival after 3 years was 89.3% (95% CI, 80% to 94%) with 30 patients at risk. The mean follow-up was 33.1 months (range, 24-48 months) with successful treatment of PJI. There were no statistical differences in infect eradication rate among the dichotomized groups.

Conclusions: High infect eradication rates were achieved in a challenging cohort using a standardized two-stage exchange supported by a multidisciplinary approach.

Keywords: Hip; Outcome; Periprosthetic joint infection; Two-stage exchange.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was reviewed and approved by the ethics committee Charite Universitätsmedizin (EA4/040/14). No consent to participate was needed.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Kaplan-Meier survivorship graph showing the infection-free survival of 84 hip PJI patients. The dotted lines represent the 95% confidence intervals
See this image and copyright information in PMC

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