Abstract
Prosthetic joint infections (PJIs) with prior multiple failed surgeries for re-infection (PMFSR) represented a huge challenge for surgeons because of poor vascular supply and biofilm formation. This study aims to determine the results of single-stage revision using intra-articular antibiotic infusion for treatment of PJIs with PMFSR.
A retrospective analysis included 78 PJIs (29 hips; 49 knees) with PMFSR, who were treated with single-stage revision using intra-articular antibiotic infusion. Previous failure was defined as infection recurrence requiring surgical intervention. Besides intravenous pathogen-sensitive agents, a intra-articular infusion of vancomycin, imipenem or voriconazole was performed post-operatively. The antibiotic solution was soaked into the joint for 24 hours then extracted before next injection. Recurrence of infection and clinical outcomes were evaluated.
Of these 78 patients, 59 had more than twice failed debridement and implant retentions, 12 patients had a failed arthroplasty resection, 3 hips underwent a failed two-stage revision and 4 cases had a failed one-stage revision before their single-stage revision. A total of 68 patients (87.1%) were free of infection at a mean follow-up time of 85 months. No significant difference in infection control rate was observed between hip and knee PJIs (89.7% versus 85.7%). The mean postoperative Harris hip score was 76.1 points and HSS score was 78. 2 at the most recent assessment.
Single-stage revision with intra-articular antibiotic infusion can provide high antibiotic concentration in synovial fluid therefore overcome poor vascular supply and biofilm formation, which can be a viable option in treating PJI with PMFSR.
