MICROBIOLOGICAL RESULTS AND CLINICAL OUTCOME OF TWO-STAGE REVISIONS WITH REPEAT FIRST-STAGE PROCEDURES IN THE TREATMENT OF PERIPROSTHETIC HIP AND KNEE JOINT INFECTIONS

B. J. H. Frank; S. Simon; A. Aichmair; M. Dominkus; G. M. Schwarz; J. G. Hofstaetter

doi:10.1302/1358-992X.2021.15.007

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General Orthopaedics

MICROBIOLOGICAL RESULTS AND CLINICAL OUTCOME OF TWO-STAGE REVISIONS WITH REPEAT FIRST-STAGE PROCEDURES IN THE TREATMENT OF PERIPROSTHETIC HIP AND KNEE JOINT INFECTIONS

The European Bone and Joint Infection Society (EBJIS), Ljubljana, Slovenia, 7–9 October 2021.

B. J. H. Frank
S. Simon
A. Aichmair
M. Dominkus
G. M. Schwarz
J. G. Hofstaetter

MICROBIOLOGICAL RESULTS AND CLINICAL OUTCOME OF TWO-STAGE REVISIONS WITH REPEAT FIRST-STAGE PROCEDURES IN THE TREATMENT OF PERIPROSTHETIC HIP AND KNEE JOINT INFECTIONS

Frank BJH, Simon S, Aichmair A, Dominkus M, Schwarz GM, Hofstaetter JG. MICROBIOLOGICAL RESULTS AND CLINICAL OUTCOME OF TWO-STAGE REVISIONS WITH REPEAT FIRST-STAGE PROCEDURES IN THE TREATMENT OF PERIPROSTHETIC HIP AND KNEE JOINT INFECTIONS. Orthop Procs. 2021;103-B(SUPP_15):7-7. doi:10.1302/1358-992X.2021.15.007

Frank, B. J. H., et al. “MICROBIOLOGICAL RESULTS AND CLINICAL OUTCOME OF TWO-STAGE REVISIONS WITH REPEAT FIRST-STAGE PROCEDURES IN THE TREATMENT OF PERIPROSTHETIC HIP AND KNEE JOINT INFECTIONS.” Orthopaedic Proceedings, vol. 103-B, no. SUPP_15, 2021, pp. 7-7., https://doi.org/10.1302/1358-992X.2021.15.007

Frank, B. J. H., Simon, S., Aichmair, A., Dominkus, M., Schwarz, G. M., & Hofstaetter, J. G. (2021). MICROBIOLOGICAL RESULTS AND CLINICAL OUTCOME OF TWO-STAGE REVISIONS WITH REPEAT FIRST-STAGE PROCEDURES IN THE TREATMENT OF PERIPROSTHETIC HIP AND KNEE JOINT INFECTIONS. Orthopaedic Proceedings, 103-B(SUPP_15), 7-7. https://doi.org/10.1302/1358-992X.2021.15.007

Frank, B. J. H., Simon, S., Aichmair, A., Dominkus, M., Schwarz, G. M. and Hofstaetter, J. G. (2021) “MICROBIOLOGICAL RESULTS AND CLINICAL OUTCOME OF TWO-STAGE REVISIONS WITH REPEAT FIRST-STAGE PROCEDURES IN THE TREATMENT OF PERIPROSTHETIC HIP AND KNEE JOINT INFECTIONS.” Orthopaedic Proceedings, 103-B(SUPP_15), pp. 7-7. Available at: https://doi.org/10.1302/1358-992X.2021.15.007

Frank, B. J. H., S. Simon, A. Aichmair, M. Dominkus, G. M. Schwarz, and J. G. Hofstaetter. “MICROBIOLOGICAL RESULTS AND CLINICAL OUTCOME OF TWO-STAGE REVISIONS WITH REPEAT FIRST-STAGE PROCEDURES IN THE TREATMENT OF PERIPROSTHETIC HIP AND KNEE JOINT INFECTIONS.” Orthopaedic Proceedings 103-B, no. SUPP_15 (2021): 7-7. https://doi.org/10.1302/1358-992X.2021.15.007

Frank BJH, Simon S, Aichmair A, Dominkus M, Schwarz GM, Hofstaetter JG. MICROBIOLOGICAL RESULTS AND CLINICAL OUTCOME OF TWO-STAGE REVISIONS WITH REPEAT FIRST-STAGE PROCEDURES IN THE TREATMENT OF PERIPROSTHETIC HIP AND KNEE JOINT INFECTIONS. Orthop Procs. 2021 Dec 1;103-B(SUPP_15):7-7. https://doi.org/10.1302/1358-992X.2021.15.007

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Abstract

Aim

Little is known about microbiological spectrum and resistance patterns as well as the clinical outcome in patients who undergo a repeat first stage procedure as part of a 2-stage revision arthroplasty for the treatment of periprosthetic hip and knee joint infections.

Methods

Between 2011 and 2019, a total of 327 2-stage revision arthroplasties were performed on 312 patients with PJI of the knee and hip at our institution. We performed a retrospective analysis of all patients, who underwent a repeat first stage procedure regarding re-revision rate, host factors, culture negative and positive stages, monomicrobial and polymicrobial infections as well as microbiological spectrum and antimicrobial resistance patterns.

Results

Overall, 52/312 (16.7%) patients (27 knee/25 hip) underwent a repeat first stage procedure. There were 35/52 (67.3%) culture positive first, 17/52 (32.7%) culture positive repeat first and 12/52 (23.1%) culture positive second stage procedures. In 13/52 (25%) patients a re-revision surgery was necessary at a median follow-up of 46.8 months (range, 12.2 to 93.3 months). High re-revision rates (10/12 [83.3%]) were found in patients with culture positive second stage and low re-revision rates (3/40 [7.5%]; p<0.01) were found in patients with culture negative second stage. The microbiological spectrum changed in 9/11 (81.8%) patients between culture positive first and repeat first stage, in 3/4 (75%) patients between culture positive repeat first and second stage and in 5/6 (83.3%) between culture positive second stage and subsequent re-revision surgery. Moreover, the antimicrobial resistance pattern changed in 6/9 (66.7%) of persistent microorganisms.

Conclusion

Microbiological results during first, repeat first and second stage procedures significantly impacted the re-revision rates and changes in microbiological spectrum and resistance patterns between stages are common. However, if eradication of the microorganism at second stage can be accomplished, low re-revision rates can be achieved, even in patients who require a repeat first stage procedure.

Email: bernhard.frank@oss.at