MICROBIOLOGICAL ANALYSIS AND OUTCOME OF DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION FOLLOWING TWO-STAGE EXCHANGE ARTHROPLASTY OF THE HIP AND KNEE

B. J.H. Frank; A. Aichmair; S. Hartmann; S. Simon; M. Dominkus; J. Hofstätter

doi:10.1302/1358-992X.2022.10.022

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General Orthopaedics

MICROBIOLOGICAL ANALYSIS AND OUTCOME OF DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION FOLLOWING TWO-STAGE EXCHANGE ARTHROPLASTY OF THE HIP AND KNEE

The European Bone and Joint Infection Society (EBJIS) Meeting, Graz, Austria, 8–10 September 2022.

B. J.H. Frank
A. Aichmair
S. Hartmann
S. Simon
M. Dominkus
J. Hofstätter

MICROBIOLOGICAL ANALYSIS AND OUTCOME OF DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION FOLLOWING TWO-STAGE EXCHANGE ARTHROPLASTY OF THE HIP AND KNEE

Frank BJ, Aichmair A, Hartmann S, Simon S, Dominkus M, Hofstätter J. MICROBIOLOGICAL ANALYSIS AND OUTCOME OF DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION FOLLOWING TWO-STAGE EXCHANGE ARTHROPLASTY OF THE HIP AND KNEE. Orthop Procs. 2022;104-B(SUPP_10):22-22. doi:10.1302/1358-992X.2022.10.022

Frank, B. J.H., et al. “MICROBIOLOGICAL ANALYSIS AND OUTCOME OF DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION FOLLOWING TWO-STAGE EXCHANGE ARTHROPLASTY OF THE HIP AND KNEE.” Orthopaedic Proceedings, vol. 104-B, no. SUPP_10, 2022, pp. 22-22., https://doi.org/10.1302/1358-992X.2022.10.022

Frank, B. J., Aichmair, A., Hartmann, S., Simon, S., Dominkus, M., & Hofstätter, J. (2022). MICROBIOLOGICAL ANALYSIS AND OUTCOME OF DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION FOLLOWING TWO-STAGE EXCHANGE ARTHROPLASTY OF THE HIP AND KNEE. Orthopaedic Proceedings, 104-B(SUPP_10), 22-22. https://doi.org/10.1302/1358-992X.2022.10.022

Frank, B. J., Aichmair, A., Hartmann, S., Simon, S., Dominkus, M. and Hofstätter, J. (2022) “MICROBIOLOGICAL ANALYSIS AND OUTCOME OF DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION FOLLOWING TWO-STAGE EXCHANGE ARTHROPLASTY OF THE HIP AND KNEE.” Orthopaedic Proceedings, 104-B(SUPP_10), pp. 22-22. Available at: https://doi.org/10.1302/1358-992X.2022.10.022

Frank, B. J.H., A. Aichmair, S. Hartmann, S. Simon, M. Dominkus, and J. Hofstätter. “MICROBIOLOGICAL ANALYSIS AND OUTCOME OF DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION FOLLOWING TWO-STAGE EXCHANGE ARTHROPLASTY OF THE HIP AND KNEE.” Orthopaedic Proceedings 104-B, no. SUPP_10 (2022): 22-22. https://doi.org/10.1302/1358-992X.2022.10.022

Frank BJ, Aichmair A, Hartmann S, Simon S, Dominkus M, Hofstätter J. MICROBIOLOGICAL ANALYSIS AND OUTCOME OF DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION FOLLOWING TWO-STAGE EXCHANGE ARTHROPLASTY OF THE HIP AND KNEE. Orthop Procs. 2022 Oct 1;104-B(SUPP_10):22-22. https://doi.org/10.1302/1358-992X.2022.10.022

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Abstract

Aim

Analysis of microbiological spectrum and resistance patterns as well as the clinical outcome of patients who underwent a Debridement, antibiotics and implant retention (DAIR) procedure in the early phase following failed two-stage exchange arthroplasty of the knee and hip.

Method

Of 312 patients treated with two-stage exchange arthroplasty between January 2011 and December 2019, 16 (5.1%) patients (9 knee, 7 hip) underwent a DAIR procedure within 6 months following second stage. We retrospectively analyzed the microbiological results as well as changes in the microbiological spectrum and antibiotic resistance patterns between stages of two-stage exchange arthroplasties and DAIR procedures. Patient's re-revision rates after a minimum follow-up of 12 months following DAIR procedure were evaluated. Moreover, differences between knee and hip and between infected primary total joint replacement (TJRs) and infected revision TJRs as well as patient's host factors and microbiological results regarding the outcome of DAIR were analyzed.

Results

In 7/16 (43.8%) patients the first and second stage procedure was culture positive, in 5/16 (31.2%) patients the first and second stage procedure was culture negative and in 4/16 (25%) patients the first stage procedure was culture positive, and the second stage procedure was culture negative. Moreover, 6 (37.5%) out of 16 DAIR procedures showed a positive microbiological result. In 5/7 (71.4%) patients with culture positive second stage procedure a different microorganism compared to first stage procedure was detected. In 6/6 (100%) patients with culture positive DAIR procedure, the isolated microorganisms were not detected during first or second stage procedure. An additional re-revision surgery was necessary in 4/16 (25%) patients after a median time of 31 months (range, 12 to 138 months) at a mean follow up of 63.1 ± 32 months following DAIR procedure. Highest re-revision rates were found in patients with culture positive second stage procedures (3/7 [42.9%]) and patients with culture positive DAIR procedures (2/6 [33.3%]).

Conclusions

DAIR procedure seems to be a useful early treatment option following failed two-stage exchange arthroplasty. The re-revision rates were independent of different combinations of culture positive and culture negative first and second stage procedures. The high number of changes in the microbiological spectrum needs to be considered in the treatment of PJI.

E-mail: bernhard.frank@oss.at