Chun-Hung Chang1,2, Shang-Wen Tsai1,2, Kuei-Hsiang Hsu1,2, Ming-Chau Chang1,2, Wei-Ming Chen1,2, Yu-Ping Su1,2,3. 1. Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. 2. Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. 3. Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan, ROC.
Abstract
BACKGROUND: We compared the clinical efficacy of normal C-reactive protein (CRP) expression (<1.0 mg/dL), with a 2-week drug holiday test (DHT) and no drug holiday test (DHT) as a reimplantation criterion, based on subsequent infections after a two-stage revision of a total knee arthroplasty of a periprosthetic joint infection (PJI). METHODS: In a 10-year review of 58 patients (mean age: 73.3-years-old; mean follow-up: 46.2 months), there were 31 patients in the DHT group and 27 patients in the DHT group. Primary outcome was recurrent infection rate. Secondary outcomes included length of hospital stay in the revision stage and CRP resurge one day before revision. RESULTS: We reported that the CRP resurge rate in the DHT group (0%) was significantly (p = 0.029) lower than that in the DHT group (16.1%) one day before the revision. The DHT group also had a significantly shorter mean length of stay (LOS) in the hospital (9.6 vs 12.7 days, p = 0.015) and a nonsignificantly lower subsequent infection rate (14.8% vs 29%, p = 0.195). CONCLUSION: We found that disciplined use of DHT as a reimplantation criterion reduced CRP resurges before reimplantation and yielded a shorter LOS afterward. DHT positively affected the subsequent mid-term infection rate after PJI treatment.
BACKGROUND: We compared the clinical efficacy of normal C-reactive protein (CRP) expression (<1.0 mg/dL), with a 2-week drug holiday test (DHT) and no drug holiday test (DHT) as a reimplantation criterion, based on subsequent infections after a two-stage revision of a total knee arthroplasty of a periprosthetic joint infection (PJI). METHODS: In a 10-year review of 58 patients (mean age: 73.3-years-old; mean follow-up: 46.2 months), there were 31 patients in the DHT group and 27 patients in the DHT group. Primary outcome was recurrent infection rate. Secondary outcomes included length of hospital stay in the revision stage and CRP resurge one day before revision. RESULTS: We reported that the CRP resurge rate in the DHT group (0%) was significantly (p = 0.029) lower than that in the DHT group (16.1%) one day before the revision. The DHT group also had a significantly shorter mean length of stay (LOS) in the hospital (9.6 vs 12.7 days, p = 0.015) and a nonsignificantly lower subsequent infection rate (14.8% vs 29%, p = 0.195). CONCLUSION: We found that disciplined use of DHT as a reimplantation criterion reduced CRP resurges before reimplantation and yielded a shorter LOS afterward. DHT positively affected the subsequent mid-term infection rate after PJI treatment.
Authors: Sam Supreeth; Suwailim Al Ghanami; Saseendar Shanmugasundaram; Raad Sabri Al Rawi; Ali Redha Abdawani; Shenouda R Abdelmasih Journal: J Clin Orthop Trauma Date: 2020-07-04