Abstract
Introduction
Single-stage resection and reimplantation for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) is of recent interest, yet outcomes may be skewed by selected populations with healthier patients and less virulent organisms. This study quantified the effectiveness of a contemporary, evidence-based and standardized two-stage treatment protocol in patients with THA PJI including chronically infected, poor hosts.
Methods
Sixty-one consecutive two-stage resection and reimplantation THAs for PJI between 2011 and 2017 were retrospectively reviewed in a prospectively collected registry database. Patients were categorized with McPherson's Staging System and infection was defined by MSIS criteria. Contemporary standardized protocols were adhered to including implant resection and meticulous surgical debridement, six-week intravenous antibiotics with a high-dose antibiotic spacer, a two-week drug holiday, and laboratory assessment of infection eradication prior to reimplantation. Extended antibiotics after reimplantation were not routinely used. Successful treatment was defined as reimplantation with component retention at minimum two-year follow-up.
Results
After exclusions for confounds, 43 of 47 patients had obtained minimum two-year follow-up (mean 50.9 months). 54% were male with an average BMI of 31 kg/m2. 56% were chronically infected poor hosts (Stage III-B/C). Three patients required repeat debridement and/or spacer exchange prior to final reimplantation. Treatment success rate was 95% at two-year follow-up. Success did not vary based on patient sex, age, BMI, or multi-organism PJI (p ≥ 0.117). There were no failures in the early postoperative PJI group (stage I), and both failures occurred in the late chronic PJI group (stage III).
Conclusion
Our success rate with the two-stage procedure equals or exceeds that of single-stage treatment, even in an unselected cohort of chronically infected poor hosts. More rigorous scientific comparative studies are warranted prior to indiscriminate adoption of the single-stage treatment approach for PJI in THA.
