What Factors Cause Hip Reimplantation to Fail after a Two-Stage Revision Hip Arthroplasty?
Article Sidebar
Published:
Aug 19, 2021
Keywords:
Periprosthetic joint infection, total hip replacement, two-stage revision surgery
Main Article Content
Abstract
Background: We analyzed the survivorship free-from-septic failure in a series of THA cases treated with a two-stage protocol at long-term follow-up, with a special focus on the relevance of positive frozen section and positive intraoperative culture taken during the reimplantation.
Methods: We retrospectively reviewed data from 96 cases who met the Musculoskeletal Infection Society criteria for periprosthetic joint infection and who had undergone both stages of a two-stage protocol at our institution between 2008-2013. Mean follow-up was 90 months. Treatment failure was determined with a modified Delphi-based consensus definition. Kaplan-Meier estimate was used to determine survivorship free-from-septic failure. Log-Rank test was used to compare variables associated with septic failure.
Results: Survival free-from-septic failure was 82.65% at 2 years (95%CI 73.25%-88.99%), 80.40% at 5 years (95%CI 70.70%-87.17%) and 77.32% at 6-10 years (95%CI 66.90%-84.33%). Patients with a positive culture at reimplantation had significantly more septic failures than those without it (Log-Rank test, p=0.0208), while patients with a positive frozen section at reimplantation had significantly more septic failures than those without it (Log-Rank test, p=0.0154).
Conclusions: Reimplantations that remained at least 6 years without septic recurrences had a very low risk of further septic failure. Both positive frozen section and intraoperative culture at reimplantation were risk factors for septic failure.
Methods: We retrospectively reviewed data from 96 cases who met the Musculoskeletal Infection Society criteria for periprosthetic joint infection and who had undergone both stages of a two-stage protocol at our institution between 2008-2013. Mean follow-up was 90 months. Treatment failure was determined with a modified Delphi-based consensus definition. Kaplan-Meier estimate was used to determine survivorship free-from-septic failure. Log-Rank test was used to compare variables associated with septic failure.
Results: Survival free-from-septic failure was 82.65% at 2 years (95%CI 73.25%-88.99%), 80.40% at 5 years (95%CI 70.70%-87.17%) and 77.32% at 6-10 years (95%CI 66.90%-84.33%). Patients with a positive culture at reimplantation had significantly more septic failures than those without it (Log-Rank test, p=0.0208), while patients with a positive frozen section at reimplantation had significantly more septic failures than those without it (Log-Rank test, p=0.0154).
Conclusions: Reimplantations that remained at least 6 years without septic recurrences had a very low risk of further septic failure. Both positive frozen section and intraoperative culture at reimplantation were risk factors for septic failure.
Downloads
Download data is not yet available.
Metrics
Metrics Loading ...
Article Details
How to Cite
García-Barreiro, G., Slullitel, P., Oñativia, J., Zanotti, G., Comba, F., Piccaluga, F., & Buttaro, M. (2021). What Factors Cause Hip Reimplantation to Fail after a Two-Stage Revision Hip Arthroplasty?. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(4), 501-511. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1325
Issue
Section
Clinical Research
Copyright (c) 2021 Revista de la Asociación Argentina de Ortopedia y Traumatología
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
References
1. Xu C, Goswami K, Li WT, Tan TL, Yayac M, Wang S-H, et al. Is treatment of periprosthetic joint infection
improving over time? J Arthroplasty 2020;35(6):1696-1702. https://doi.org/10.1016/j.arth.2020.01.080
2. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United
States. J Arthroplasty 2012;27(8):61-65.e1. https://doi.org/10.1016/j.arth.2012.02.022
3. Matthews PC, Berendt AR, McNally MA, Byren I. Diagnosis and management of prosthetic joint infection. BMJ
2009;338:b1773. https://doi.org/10.1136/bmj.b1773
4. Berend KR, Lombardi AV, Morris MJ, Bergeson AG, Adams JB, Sneller MA. Two-stage treatment of hip
periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res 2013;471(2):510-8. https://doi.org/10.1007/s11999-012-2595-x
5. Wang Q, Goswami K, Kuo F-C, Xu C, Tan TL, Parvizi J. Two-stage exchange arthroplasty for periprosthetic joint
infection: the rate and reason for the attrition after the first stage. J Arthroplasty 2019;34(11):2749-56.
https://doi.org/10.1016/j.arth.2019.06.021
6. Tan TL, Goswami K, Fillingham YA, Shohat N, Rondon AJ, Parvizi J. Defining treatment success after 2-stage
exchange arthroplasty for periprosthetic joint infection. J Arthroplasty 2018;33(11):3541-6.
https://doi.org/10.1016/j.arth.2018.06.015
7. Watts CD, Wagner ER, Houdek MT, Osmon DR, Hanssen AD, Lewallen DG, et al. Morbid obesity: a
significant risk factor for failure of two-stage revision total knee arthroplasty for infection. J Bone Joint Surg Am
2014;96(18):e154-1-7. https://doi.org/10.2106/JBJS.M.01289
8. Corona PS, Barro V, Mendez M, Cáceres E, Flores X. Industrially prefabricated cement spacers: do vancomycinand gentamicin-impregnated spacers offer any advantage? Clin Orthop Relat Res 2014;472(3):923-32.
https://doi.org/10.1007/s11999-013-3342-7
9. Frangiamore SJ, Siqueira MBP, Saleh A, Daly T, Higuera CA, Barsoum WK. Synovial cytokines and the MSIS
criteria are not useful for determining infection resolution after periprosthetic joint infection explantation. Clin
Orthop Relat Res 2016;474(7):1630-9. https://doi.org/10.1007/s11999-016-4710-x
10. Della Valle CJ, Bogner E, Desai P, Lonner JH, Adler E, Zuckerman JD, et al. Analysis of frozen sections of
intraoperative specimens obtained at the time of reoperation after hip or knee resection arthroplasty for the treatment of infection. J Bone Joint Surg Am 1999;81(5):684-9. https://doi.org/10.2106/00004623-199905000-00009
11. George J, Kwiecien G, Klika AK, Ramanathan D, Bauer TW, Barsoum WK, et al. Are frozen sections and
MSIS criteria reliable at the time of reimplantation of two-stage revision arthroplasty? Clin Orthop Relat Res
2016;474(7):1619-26. https://doi.org/10.1007/s11999-015-4673-3
12. Parvizi J, Gehrke T. Definition of periprosthetic joint infection. J Arthroplasty 2014;29(7):1331.
https://doi.org/10.1016/j.arth.2014.03.009
13. Buttaro MA, Martorell G, Quinteros M, Comba F, Zanotti G, Piccaluga F. Intraoperative synovial C-reactive protein is as useful as frozen section to detect periprosthetic hip infection. Clin Orthop Relat Res 2015;473(12):3876-81. https://doi.org/10.1007/s11999-015-4340-8
14. Aribindi R, Barba M, Solomon MI, Arp P, Paprosky W. Bypass fixation. Orthop Clin North Am 1998;29(2):319-29. https://doi.org/10.1016/s0030-5898(05)70330-8
15. Nuñez LV, Buttaro MA, Morandi A, Pusso R, Piccaluga F. Frozen sections of samples taken intraoperatively for
diagnosis of infection in revision hip surgery. Acta Orthop 2007;78(2):226-30. https://doi.org/10.1080/17453670710013726
16. Diaz-Ledezma C, Higuera CA, Parvizi J. Success after treatment of periprosthetic joint infection: a Delphi-based International Multidisciplinary Consensus. Clin Orthop Relat Res 2013;471(7):2374-82.
https://doi.org/10.1007/s11999-013-2866-1
17. Akgün D, Müller M, Perka C, Winkler T. A positive bacterial culture during re-implantation is associated with a
poor outcome in two-stage exchange arthroplasty for deep infection. Bone Joint J 2017;99-B(11):1490-5.
https://doi.org/10.1302/0301-620X.99B11.BJJ-2017-0243-R1
18. Petis SM, Abdel MP, Perry KI, Mabry TM, Hanssen AD, Berry DJ. Long-term results of a 2-stage exchange
protocol for periprosthetic joint infection following total hip arthroplasty in 164 hips. J Bone Joint Surg Am
2019;101(1):74-84. https://doi.org/10.2106/JBJS.17.01103
19. Leonard HAC, Liddle AD, Burke O, Murray DW, Pandit H. Single- or two-stage revision for infected total hip
arthroplasty? A systematic review of the literature. Clin Orthop Relat Res 2014;472(3):1036-42. https://doi.org/10.1007/s11999-013-3294-y
20. Siqueira MBP, Saleh A, Klika AK, O’Rourke C, Schmitt S, Higuera CA, et al. Chronic suppression of periprosthetic joint infections with oral antibiotics increases infection-free survivorship. J Bone Joint Surg Am 2015;97(15):1220-32. https://doi.org/10.2106/JBJS.N.00999
21. Aalirezaie A, Bauer TW, Fayaz H, Griffin W, Higuera CA, Krenn V, et al. Hip and Knee Section, Diagnosis,
Reimplantation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019;34(2):S369-79. https://doi.org/10.1016/j.arth.2018.09.021
22. Ghanem E, Azzam K, Seeley M, Joshi A, Parvizi J. Staged revision for knee arthroplasty infection: what is the role of serologic tests before reimplantation? Clin Orthop Relat Res 2009;467(7):1699-705. https://doi.org/10.1007/s11999-009-0742-9
23. Chimento GF, Finger S, Barrack RL. Gram stain detection of infection during revision arthroplasty. J Bone Joint
Surg Br 1996;78(5):838-9. PMID: 8836084
24. Janz V, Schoon J, Morgenstern C, Preininger B, Reinke S, Duda G, et al. Rapid detection of periprosthetic joint
infection using a combination of 16s rDNA polymerase chain reaction and lateral flow immunoassay. Bone Joint
Res 2018;7(1):12-9. https://doi.org/10.1302/2046-3758.71.BJR-2017-0103.R2
25. Lee YS, Fernando N, Koo K-H, Kim HJ, Vahedi H, Chen AF. What markers best guide the timing of reimplantation in two-stage exchange arthroplasty for PJI? A systematic review and meta-analysis. Clin Orthop Relat Res 2018;476(10):1972-83. https://doi.org/10.1097/01.blo.0000534680.87622.43
improving over time? J Arthroplasty 2020;35(6):1696-1702. https://doi.org/10.1016/j.arth.2020.01.080
2. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United
States. J Arthroplasty 2012;27(8):61-65.e1. https://doi.org/10.1016/j.arth.2012.02.022
3. Matthews PC, Berendt AR, McNally MA, Byren I. Diagnosis and management of prosthetic joint infection. BMJ
2009;338:b1773. https://doi.org/10.1136/bmj.b1773
4. Berend KR, Lombardi AV, Morris MJ, Bergeson AG, Adams JB, Sneller MA. Two-stage treatment of hip
periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res 2013;471(2):510-8. https://doi.org/10.1007/s11999-012-2595-x
5. Wang Q, Goswami K, Kuo F-C, Xu C, Tan TL, Parvizi J. Two-stage exchange arthroplasty for periprosthetic joint
infection: the rate and reason for the attrition after the first stage. J Arthroplasty 2019;34(11):2749-56.
https://doi.org/10.1016/j.arth.2019.06.021
6. Tan TL, Goswami K, Fillingham YA, Shohat N, Rondon AJ, Parvizi J. Defining treatment success after 2-stage
exchange arthroplasty for periprosthetic joint infection. J Arthroplasty 2018;33(11):3541-6.
https://doi.org/10.1016/j.arth.2018.06.015
7. Watts CD, Wagner ER, Houdek MT, Osmon DR, Hanssen AD, Lewallen DG, et al. Morbid obesity: a
significant risk factor for failure of two-stage revision total knee arthroplasty for infection. J Bone Joint Surg Am
2014;96(18):e154-1-7. https://doi.org/10.2106/JBJS.M.01289
8. Corona PS, Barro V, Mendez M, Cáceres E, Flores X. Industrially prefabricated cement spacers: do vancomycinand gentamicin-impregnated spacers offer any advantage? Clin Orthop Relat Res 2014;472(3):923-32.
https://doi.org/10.1007/s11999-013-3342-7
9. Frangiamore SJ, Siqueira MBP, Saleh A, Daly T, Higuera CA, Barsoum WK. Synovial cytokines and the MSIS
criteria are not useful for determining infection resolution after periprosthetic joint infection explantation. Clin
Orthop Relat Res 2016;474(7):1630-9. https://doi.org/10.1007/s11999-016-4710-x
10. Della Valle CJ, Bogner E, Desai P, Lonner JH, Adler E, Zuckerman JD, et al. Analysis of frozen sections of
intraoperative specimens obtained at the time of reoperation after hip or knee resection arthroplasty for the treatment of infection. J Bone Joint Surg Am 1999;81(5):684-9. https://doi.org/10.2106/00004623-199905000-00009
11. George J, Kwiecien G, Klika AK, Ramanathan D, Bauer TW, Barsoum WK, et al. Are frozen sections and
MSIS criteria reliable at the time of reimplantation of two-stage revision arthroplasty? Clin Orthop Relat Res
2016;474(7):1619-26. https://doi.org/10.1007/s11999-015-4673-3
12. Parvizi J, Gehrke T. Definition of periprosthetic joint infection. J Arthroplasty 2014;29(7):1331.
https://doi.org/10.1016/j.arth.2014.03.009
13. Buttaro MA, Martorell G, Quinteros M, Comba F, Zanotti G, Piccaluga F. Intraoperative synovial C-reactive protein is as useful as frozen section to detect periprosthetic hip infection. Clin Orthop Relat Res 2015;473(12):3876-81. https://doi.org/10.1007/s11999-015-4340-8
14. Aribindi R, Barba M, Solomon MI, Arp P, Paprosky W. Bypass fixation. Orthop Clin North Am 1998;29(2):319-29. https://doi.org/10.1016/s0030-5898(05)70330-8
15. Nuñez LV, Buttaro MA, Morandi A, Pusso R, Piccaluga F. Frozen sections of samples taken intraoperatively for
diagnosis of infection in revision hip surgery. Acta Orthop 2007;78(2):226-30. https://doi.org/10.1080/17453670710013726
16. Diaz-Ledezma C, Higuera CA, Parvizi J. Success after treatment of periprosthetic joint infection: a Delphi-based International Multidisciplinary Consensus. Clin Orthop Relat Res 2013;471(7):2374-82.
https://doi.org/10.1007/s11999-013-2866-1
17. Akgün D, Müller M, Perka C, Winkler T. A positive bacterial culture during re-implantation is associated with a
poor outcome in two-stage exchange arthroplasty for deep infection. Bone Joint J 2017;99-B(11):1490-5.
https://doi.org/10.1302/0301-620X.99B11.BJJ-2017-0243-R1
18. Petis SM, Abdel MP, Perry KI, Mabry TM, Hanssen AD, Berry DJ. Long-term results of a 2-stage exchange
protocol for periprosthetic joint infection following total hip arthroplasty in 164 hips. J Bone Joint Surg Am
2019;101(1):74-84. https://doi.org/10.2106/JBJS.17.01103
19. Leonard HAC, Liddle AD, Burke O, Murray DW, Pandit H. Single- or two-stage revision for infected total hip
arthroplasty? A systematic review of the literature. Clin Orthop Relat Res 2014;472(3):1036-42. https://doi.org/10.1007/s11999-013-3294-y
20. Siqueira MBP, Saleh A, Klika AK, O’Rourke C, Schmitt S, Higuera CA, et al. Chronic suppression of periprosthetic joint infections with oral antibiotics increases infection-free survivorship. J Bone Joint Surg Am 2015;97(15):1220-32. https://doi.org/10.2106/JBJS.N.00999
21. Aalirezaie A, Bauer TW, Fayaz H, Griffin W, Higuera CA, Krenn V, et al. Hip and Knee Section, Diagnosis,
Reimplantation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019;34(2):S369-79. https://doi.org/10.1016/j.arth.2018.09.021
22. Ghanem E, Azzam K, Seeley M, Joshi A, Parvizi J. Staged revision for knee arthroplasty infection: what is the role of serologic tests before reimplantation? Clin Orthop Relat Res 2009;467(7):1699-705. https://doi.org/10.1007/s11999-009-0742-9
23. Chimento GF, Finger S, Barrack RL. Gram stain detection of infection during revision arthroplasty. J Bone Joint
Surg Br 1996;78(5):838-9. PMID: 8836084
24. Janz V, Schoon J, Morgenstern C, Preininger B, Reinke S, Duda G, et al. Rapid detection of periprosthetic joint
infection using a combination of 16s rDNA polymerase chain reaction and lateral flow immunoassay. Bone Joint
Res 2018;7(1):12-9. https://doi.org/10.1302/2046-3758.71.BJR-2017-0103.R2
25. Lee YS, Fernando N, Koo K-H, Kim HJ, Vahedi H, Chen AF. What markers best guide the timing of reimplantation in two-stage exchange arthroplasty for PJI? A systematic review and meta-analysis. Clin Orthop Relat Res 2018;476(10):1972-83. https://doi.org/10.1097/01.blo.0000534680.87622.43