Tobias Winkler1,2,3,4, Malte G W Stuhlert5,6, Elke Lieb5,6, Michael Müller5,6, Philipp von Roth5,6, Bernd Preininger5,6, Andrej Trampuz5,7,6, Carsten F Perka5,6. 1. Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353, Berlin, Germany. tobias.winkler@charite.de. 2. Julius Wolff Institute, Berlin, Germany. tobias.winkler@charite.de. 3. Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany. tobias.winkler@charite.de. 4. Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany. tobias.winkler@charite.de. 5. Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353, Berlin, Germany. 6. Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany. 7. Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany.
Abstract
INTRODUCTION: A two-stage exchange is the standard treatment approach for chronic periprosthetic joint infection (PJI). While a 6-8 week interval is commonly used before reimplantation, the optimal length of the prosthesis-free interval has not yet been determined. We evaluated the influence of a short (< 4 weeks) and long (≥ 4 weeks) interval on reinfection rate and functional outcome of hip and knee PJI. METHODS: In this prospective cohort, patients undergoing two-stage revision for PJI were assigned to prosthesis reimplantation after a short (< 4 weeks) or long (≥ 4 weeks) interval. All patients received standardized antimicrobial therapy, which consisted of antibiogram-adapted, non-biofilm-active antibiotics during the interval and an antimicrobial combination therapy with biofilm-active antibiotics after reimplantation. Follow-up was performed for infection, joint function, pain, need for care and quality of life. RESULTS: Thirty-eight patients undergoing two-stage revision for PJI (18 hips and 20 knees) were included. Short interval was used in 19 patients having a mean interval of 17.9 days (range 7-27 days), long interval in 19 patients having a mean interval of 63.0 days (range 28-204 days). At a mean follow-up of 39.5 months (range 32-48 months), 37 of 38 patients (97.4%) were infection-free. One failure occurred among patients with long interval and none among patients with short interval. Functional results (ROM, HHS, KSS, VAS) and quality of life (SF-36) were similar in both groups. Patients treated with long interval required cumulatively additional 204 inpatient days for nursing care compared to patients with short interval. CONCLUSIONS: This study suggests that two-stage exchange with short interval has a similar outcome than with long interval, when highly active antibiotic therapy is used. Patient inconvenience and care costs due to immobilization were lower when strategies with a short interval were used.
INTRODUCTION: A two-stage exchange is the standard treatment approach for chronic periprosthetic joint infection (PJI). While a 6-8 week interval is commonly used before reimplantation, the optimal length of the prosthesis-free interval has not yet been determined. We evaluated the influence of a short (< 4 weeks) and long (≥ 4 weeks) interval on reinfection rate and functional outcome of hip and knee PJI. METHODS: In this prospective cohort, patients undergoing two-stage revision for PJI were assigned to prosthesis reimplantation after a short (< 4 weeks) or long (≥ 4 weeks) interval. All patients received standardized antimicrobial therapy, which consisted of antibiogram-adapted, non-biofilm-active antibiotics during the interval and an antimicrobial combination therapy with biofilm-active antibiotics after reimplantation. Follow-up was performed for infection, joint function, pain, need for care and quality of life. RESULTS: Thirty-eight patients undergoing two-stage revision for PJI (18 hips and 20 knees) were included. Short interval was used in 19 patients having a mean interval of 17.9 days (range 7-27 days), long interval in 19 patients having a mean interval of 63.0 days (range 28-204 days). At a mean follow-up of 39.5 months (range 32-48 months), 37 of 38 patients (97.4%) were infection-free. One failure occurred among patients with long interval and none among patients with short interval. Functional results (ROM, HHS, KSS, VAS) and quality of life (SF-36) were similar in both groups. Patients treated with long interval required cumulatively additional 204 inpatient days for nursing care compared to patients with short interval. CONCLUSIONS: This study suggests that two-stage exchange with short interval has a similar outcome than with long interval, when highly active antibiotic therapy is used. Patient inconvenience and care costs due to immobilization were lower when strategies with a short interval were used.
Authors: Laurens Manning; Sarah Metcalf; Benjamin Clark; James Owen Robinson; Paul Huggan; Chris Luey; Stephen McBride; Craig Aboltins; Renjy Nelson; David Campbell; Lucian Bogdan Solomon; Kellie Schneider; Mark Loewenthal; Piers Yates; Eugene Athan; Darcie Cooper; Babak Rad; Tony Allworth; Alistair Reid; Kerry Read; Peter Leung; Archana Sud; Vana Nagendra; Roy Chean; Chris Lemoh; Nora Mutalima; Kate Grimwade; Marjorie Sehu; Adrienne Torda; Thi Aung; Steven Graves; David Paterson; Josh Davis Journal: Open Forum Infect Dis Date: 2020-05-14 Impact factor: 3.835