scholarly journals Prosthetic Joint Infection: Report on the One versus Two-stage Exchange EBJIS Survey

2016 ◽  
Vol 1 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Pedro Santos Leite ◽  
Sérgio Figueiredo ◽  
Ricardo Sousa
Keyword(s):  
Prosthetic Joint Infection ◽  
Revision Surgery ◽  
Joint Infection ◽  
Clinical Aspects ◽  
Online Questionnaire ◽  
Two Stage ◽  
Significant Group ◽  
One Stage ◽  
Prosthetic Joint ◽  
Multicentre Research

Abstract. Background: Prosthetic Joint Infection (PJI) is one of the most challenging problems in orthopaedic surgery and musculoskeletal infections specifically. Some very important controversies remain and strong evidence-based recommendations are still lacking in many clinical aspects. Therefore, an undisputed methodology of treatment does not exist yet and there are many different valid approaches.Purposes: To draw a picture of the different practice patterns around Europe and understand the motivations of the European Bone & Joint Infection Society (EBJIS) members in choosing between one- or two-stage revision surgery in treating chronic PJI.Methods: The participants of the 34th EBJIS Annual Meeting were surveyed through an online questionnaire. The survey assessed the main philosophy in the treatment of chronic PJI, personal and institutional information as well as the importance of different factors in choosing two-stage or one-stage procedures.Results: One hundred and forty-three participants responded to the survey, including a significant group of skilful orthopaedic surgeons with large experience in treating musculoskeletal infections. Primarily two-stage was the most common philosophy regrading treatment of chronic PJI (60.1%), followed by two-stage or one-stage accordingly (34,8%) and primarily one-stage (5,1%). Significant soft tissue compromise, failure of previous revision surgery attempts, highly resistant or unclear infective microorganism(s) preoperatively and patient presenting with sepsis or immunosuppression, were considered the more relevant factors in choosing two-stage instead one-stage procedures.Interpretation: Treatment of chronic PJI is challenging and demanding. An open dialogue to share the different experiences and a collective effort to plan a major multicentre research in order to establish standardized protocols are essential.

scholarly journals 257. Outcomes in Fungal Prosthetic Joint Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S235-S235
Author(s):  
Caitlyn M Hollingshead ◽  
Joan Duggan ◽  
Roberta Redfern ◽  
Gregory Georgiadis ◽  
Jason Tank
Keyword(s):  
Prosthetic Joint Infection ◽  
Candida Species ◽  
Joint Infection ◽  
Two Stage ◽  
One Stage ◽  
Prosthetic Joint ◽  
Hip Replacements ◽  
Fungal Organisms ◽  
Poor Outcomes ◽  
Wbc Count

Abstract Background There is a paucity of data in the literature regarding the most effective treatment and related outcomes of fungal prosthetic joint infection. The majority of reported cases are treated using a two stage revision method in which the initial prosthesis is removed and the patient is treated with systemic antifungal medications and potentially irrigation of the joint cavity with antifungal and antibacterial agents. Alternately, others have suggested a one-stage revision in order to prevent a period of significant functional impairment and potentially improved functional outcomes and lower overall costs. Cases of radical removal of the prosthesis without replacement have been reported. To date, the largest studies of total hip arthroplasty and total knee arthroplasty have included 37 and 45 patients, respectively. Methods A retrospective record review of patients admitted within two health systems between January 1, 2007 and December 31, 2018 with prosthetic joints and a deep culture of the joint positive for fungal organisms was performed. Results Eighteen patients fit criteria. Nine patients had knee replacements and nine patients had hip replacements. The average age at time of infection was 61. Ten patients were female. Average BMI was 32.1. Twelve presented with a painful joint, eight presented with drainage, and one with dehiscence. Average WBC count was 9.3, average ESR was 47, and average CRP was 11.8. All patients were noted with Candida species. Eight patients were treated with two stage revisions, three received one stage revisions as destination therapy. One required amputation. All but one patient was associated with concurrent bacterial infection. Of the twelve patients that had known outcomes, six were noted with cure and six were noted with relapse. All patients that were cured received two stage exchange or girdlestone procedure. Conclusion In our study, fungal prosthetic joint infection was associated with poor outcomes. All of the patients in our study were noted with Candida species, which is in concordance with the known literature. Two stage exchange was associated with better outcomes. Disclosures All Authors: No reported disclosures

scholarly journals Prosthetic joint infection following total hip replacement: results of one-stage versus two-stage exchange

2014 ◽  
Vol 38 (7) ◽  
pp. 1363-1368 ◽  
Author(s):  
Matthias Wolf ◽  
Heimo Clar ◽  
Jörg Friesenbichler ◽  
Gerold Schwantzer ◽  
Gerwin Bernhardt ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Prosthetic Joint Infection ◽  
Hip Replacement ◽  
Joint Infection ◽  
Stage Versus ◽  
Two Stage ◽  
Total Hip ◽  
One Stage ◽  
Prosthetic Joint

scholarly journals A spacer infection by Candida albicans secondary to a Staphylococcus capitis prosthetic joint infection: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marta Bottagisio ◽  
Alessandro Bidossi ◽  
Nicola Logoluso ◽  
Antonio Pellegrini ◽  
Elena De Vecchi
Keyword(s):  
Candida Albicans ◽  
Synovial Fluid ◽  
Prosthetic Joint Infection ◽  
Revision Surgery ◽  
Hip Prosthesis ◽  
Joint Infection ◽  
Microbiological Analysis ◽  
Two Stage ◽  
Staphylococcus Capitis ◽  
Prosthetic Joint

Abstract Background Prosthetic joint infection (PJI) is one of the most feared complications following total arthroplasty surgeries. Gram-positive bacteria are the most common microorganisms implicated in PJIs, while infections mediated by fungi only account for 1% of cases. When dealing with PJIs, a two-stage revision arthroplasty is widely used. Briefly, a spacer is introduced until re-implantation of the definitive prosthesis to provide skeleton stabilization while delivering antibiotics in the site of the infection. Sometimes, antimicrobial therapy may fail, but the isolation of a second microorganism from the spacer is uncommon and even less frequent that of a yeast. Case presentation Here is described a case of a 75-year-old woman who underwent two-stage revision surgery of the left hip prosthesis secondary to a Staphylococcus capitis infection, whose spacer was found to be infected by Candida albicans at a later time. Briefly, the patient underwent revision surgery of the hip prosthesis for a suspected PJI. After the debridement of the infected tissue, an antibiotic-loaded spacer was implanted. The microbiological analysis of the periprosthetic tissues and the implant depicted a S. capitis infection that was treated according to the antimicrobial susceptibility profile of the clinical isolate. Three months later, the patient was admitted to the emergency room due to local inflammatory signs. Synovial fluid was sent to the laboratory for culture. No evidence of S. capitis was detected, however, a yeast was identified as Candida albicans. Fifteen days later, the patient was hospitalized for the removal of the infected spacer. Microbiological cultures confirmed the results of the synovial fluid analysis. According to the susceptibility profile, the patient was treated with fluconazole (400 mg/day) for 6 months. Seven months later, the patient underwent second-stage surgery. The microbiological tests on the spacer were all negative. After 12 months of follow-up, the patient has fully recovered and no radiological signs of infection have been detected. Conclusions Given the exceptionality of this complication, it is important to report these events to better understand the clinical outcomes after the selected therapeutic options to prevent and forestall the development of either bacterial or fungal spacer infections.

Two-Stage Arthroplasty for Prosthetic Joint Infection

2013 ◽  
Vol 28 (9) ◽  
pp. 1490-1498.e1 ◽  
Author(s):  
Andrew Luu ◽  
Fahd Syed ◽  
Gowri Raman ◽  
Anshul Bhalla ◽  
Eavan Muldoon ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Two Stage ◽  
Prosthetic Joint

Outcomes of repeat two-stage exchange hip arthroplasty for prosthetic joint infection

2019 ◽  
Vol 101-B (6_Supple_B) ◽  
pp. 110-115 ◽  
Author(s):  
N. Khan ◽  
D. Parmar ◽  
M. S. Ibrahim ◽  
B. Kayani ◽  
F. S. Haddad
Keyword(s):  
Hip Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Antimicrobial Treatment ◽  
Successful Outcome ◽  
Two Stage ◽  
Persistent Symptoms ◽  
Prosthetic Joint ◽  
Revision Tha

Aims The increasing infection burden after total hip arthroplasty (THA) has seen a rise in the use of two-stage exchange arthroplasty and the use of increasingly powerful antibiotics at the time of this procedure. As a result, there has been an increase in the number of failed two-stage revisions during the past decade. The aim of this study was to clarify the outcome of repeat two-stage revision THA following a failed two-stage exchange due to recurrent prosthetic joint infection (PJI). Patients and Methods We identified 42 patients who underwent a two-stage revision THA having already undergone at least one previous two stage procedure for infection, between 2000 and 2015. There were 23 women and 19 men. Their mean age was 69.3 years (48 to 81). The outcome was analyzed at a minimum follow-up of two years. Results A satisfactory control of infection and successful outcome was seen in 26 patients (57%). There therefore remained persistent symptoms that either required further surgery or chronic antibiotic suppression in 16 patients (38%). One-third of patients had died by the time of two years’ follow-up. Conclusion The rate of failure and complication rate of repeat two-stage exchange THA for PJI is high and new methods of treatment including host optimization, immunomodulation, longer periods between stages, and new and more powerful forms of antimicrobial treatment should be investigated. Cite this article: Bone Joint J 2019;101-B(6 Supple B):110–115.

scholarly journals Post-surgery and recovery experiences following one- and two-stage revision for prosthetic joint infection—A qualitative study of patients’ experiences

PLoS ONE ◽  
2020 ◽  
Vol 15 (8) ◽  
pp. e0237047 ◽  
Author(s):  
Cecily K. Palmer ◽  
Rachael Gooberman-Hill ◽  
Ashley W. Blom ◽  
Michael R. Whitehouse ◽  
Andrew J. Moore
Keyword(s):  
Qualitative Study ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Two Stage ◽  
Post Surgery ◽  
Prosthetic Joint ◽  
Recovery Experiences

scholarly journals Management strategies for prosthetic joint infection: long-term infection control rates, overall survival rates, functional and quality of life outcomes

2021 ◽  
Vol 6 (9) ◽  
pp. 727-734
Author(s):  
Theofilos Karachalios ◽  
George A. Komnos
Keyword(s):  
Quality Of Life ◽  
Joint Infection ◽  
Management Strategies ◽  
Survival Rates ◽  
Outcome Data ◽  
Life Outcomes ◽  
Two Stage ◽  
One Stage ◽  
Prosthetic Joint

DAIR (debridement, antibiotics, and implant retention), one-stage and two-stage revision surgery are the most common management strategies for prosthetic joint infection (PJI) management. Our knowledge concerning their efficacy is based on short to medium-term low-quality studies. Most studies report infection recurrence rates or infection-free time intervals. However, long-term survival rates of the infection-free joints, functional and quality of life outcome data are of paramount importance. DAIR, one-stage and two-stage revision strategies are not unique surgical techniques, presenting several variables. Infection control rates for the above strategies vary from 75% to 90%, but comparisons are difficult because different indications and patient selection criteria are used in each strategy. Recent outcome data show that DAIR and one-stage revision in selected patients (based on host, bacteriological, soft tissue and type of infection criteria) may present improved functional and quality of life outcomes and reduced costs for health systems as compared to those of two-stage revision. It is expected that health system administrators and providers will apply pressure on surgeons and departments towards the wider use of DAIR and one-stage revision strategies. It is the orthopaedic surgeon’s responsibility to conduct quality studies in order to fully clarify the indications and outcomes of the different revision strategies. Cite this article: EFORT Open Rev 2021;6:727-734. DOI: 10.1302/2058-5241.6.210008

Complications in the treatment of prosthetic joint infection

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 145-150 ◽  
Author(s):  
Molly A. Hartzler ◽  
Katherine Li ◽  
Michael B. Geary ◽  
Susan Marie Odum ◽  
Bryan D. Springer
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Definitive Treatment ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Exchange Arthroplasty ◽  
Prosthetic Joint ◽  
Definition Of Success ◽  
One Year ◽  
Definition Of

Aims Two-stage exchange arthroplasty is the most common definitive treatment for prosthetic joint infection (PJI) in the USA. Complications that occur during treatment are often not considered. The purpose of this study was to analyze complications in patients undergoing two-stage exchange for infected total knee arthroplasty (TKA) and determine when they occur. Methods We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI of the knee from January 2010 to December 2018 at a single institution. We categorized complications as medical versus surgical. The intervals for complications were divided into: interstage; early post-reimplantation (three months); and late post-reimplantation (three months to minimum one year). Minimum follow-up was one year. In total, 134 patients underwent a first stage of a two-stage exchange. There were 69 males and 65 females with an mean age at first stage surgery of 67 years (37 to 89). Success was based on the new Musculoskeletal Infection Society (MSIS) definition of success reporting. Results Overall, 70 (52%) patients experienced a complication during the planned two-stage treatment, 36 patients (27%) experienced a medical complication and 47 (41%) patients experienced a surgical complication. There was an 18% mortality rate (24/134) at a mean of 3.7 years (0.09 to 8.3). During the inter-stage period, 28% (37/134) of patients experienced a total of 50 complications at a median of 47 days (interquartile range (IQR) 18 to 139). Of these 50 complications, 22 were medical and 28 required surgery. During this inter-stage period, four patients died (3%) and an additional five patients (4%) failed to progress to the second stage. While 93% of patients (125/134) were reimplanted, only 56% (77/134) of the patients were successfully treated without antibiotic suppression (36%, 28/77) or with antibiotic suppression (19%, 15/77) at one year. Conclusion Reported rates of success of two stage exchanges for PJI have not traditionally considered complications in the definition of success. In our series, significant numbers of patients experienced complications, more often after reimplantation, highlighting the morbidity of this method of treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):145–150.

Sign in / Sign up

Export Citation Format

Share Document