Marjan Wouthuyzen-Bakker1, Marine Sebillotte2, Jose Lomas3, Benjamin Kendrick3, Eva Benavent Palomares4, Oscar Murillo4, Javad Parvizi5, Noam Shohat6, Javier Cobo Reinoso7, Rosa Escudero Sánchez7, Marta Fernandez-Sampedro8, Eric Senneville9, Kaisa Huotari10, José Maria Barbero Allende11, Antonio Blanco García12, Jaime Lora-Tamayo13, Matteo Carlo Ferrari14, Danguole Vaznaisiene15, Erlangga Yusuf16, Craig Aboltins17, Rihard Trebse18, Mauro José Salles19, Natividad Benito20, Andrea Vila21, Maria Dolores Del Toro22, Tobias Siegfried Kramer23, Sabine Petersdorf24, Vicens Diaz-Brito25, Zeliha Kocak Tufan26, Marisa Sanchez27, Cédric Arvieux28, Alex Soriano29. 1. Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands. Electronic address: m.wouthuyzen-bakker@umcg.nl. 2. Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France. 3. Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England. 4. Infectious Disease Service, IDIBELL-Hospital Universitari Bellvitge, Barcelona, Spain. 5. Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, United States. 6. Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, United States; Department of Orthopaedic Surgery, Tel Aviv University, Tel Aviv, Israel. 7. Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain. 8. Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marques de Valdecilla-IDIVAL, Cantabria, Spain. 9. Department of Infectious Diseases, University Hospital Gustave Dron Hospital, Tourcoing, France. 10. Inflammation Center, Infectious Diseases, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Finland. 11. Department of Internal Medicine, Hospital Universitario Principe de Asturias, Madrid, Spain. 12. Department of Internal Medicine-Emergency, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain. 13. Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Madrid, Spain. 14. Department of Prosthetic Joint Replacement and Rehabilitation Center, Humanitas Research Hospital and Humanitas University, Milan, Italy. 15. Department of Infectious Diseases, Medical Academy, Lithuanian University of Health Sciences, Kaunas Clinical Hospital, Kaunas, Lithuania. 16. Department of Microbiology, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium. 17. The Department of Infectious Diseases, Northern Health, Melbourne, Australia; Northern Clinical School, The University of Melbourne, Melbourne, Australia. 18. Service for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, Slovenia. 19. Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brasil. 20. Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. 21. Servicio de Infectología, Hospital Italiano de Mendoza, Mendoza, Argentina. 22. Unidad Clínica de Enfermedades Infecciosa y Microbiología, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain. 23. Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen am Institut für Hygiene und Umweltmedizin Charité-Universitätsmedizin, Berlin, Germany; LADR, GmbH MVZ, Neuruppin, Germany. 24. Institute of Medical Microbiology, Hospital Hygiene University Hospital, Heinrich-Heine-University. Düsseldorf, Germany. 25. Infectious Diseases Unit, Parc Sanitari Sant Joan de Deu, IDIBAPS, Sant Boi, Barcelona, Spain. 26. Infectious Diseases and Clinical Microbiology Department, Ankara Yildirim Beyazit University, Ataturk Training & Research Hospital, Ankara, Turkey. 27. Infectious Diseases Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Argentina. 28. Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France; Great West Reference centers for Complex Bone and Joint Infections (CRIOGO), France. 29. Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain.
Abstract
OBJECTIVES: We evaluated the treatment outcome in late acute (LA) periprosthetic joint infections (PJI) treated with debridement and implant retention (DAIR) versus implant removal. METHODS: In a large multicenter study, LA PJIs of the hip and knee were retrospectively evaluated. Failure was defined as: PJI related death, prosthesis removal or the need for suppressive antibiotic therapy. LA PJI was defined as acute symptoms <3 weeks in patients more than 3 months after the index surgery and with a history of normal joint function. RESULTS: 445 patients were included, comprising 340 cases treated with DAIR and 105 cases treated with implant removal (19% one-stage revision (n = 20), 74.3% two-stage revision (n = 78) and 6.7% definitive implant removal (n = 7). Overall failure in patients treated with DAIR was 45.0% (153/340) compared to 24.8% (26/105) for implant removal (p < 0.001). Difference in failure rate remained after 1:1 propensity-score matching. A preoperative CRIME80-score ≥3 (OR 2.9), PJI caused by S. aureus (OR 1.8) and implant retention (OR 3.1) were independent predictors for failure in the multivariate analysis. CONCLUSION: DAIR is a viable surgical treatment for most patients with LA PJI, but implant removal should be considered in a subset of patients, especially in those with a CRIME80-score ≥3.
OBJECTIVES: We evaluated the treatment outcome in late acute (LA) periprosthetic joint infections (PJI) treated with debridement and implant retention (DAIR) versus implant removal. METHODS: In a large multicenter study, LA PJIs of the hip and knee were retrospectively evaluated. Failure was defined as: PJI related death, prosthesis removal or the need for suppressive antibiotic therapy. LA PJI was defined as acute symptoms <3 weeks in patients more than 3 months after the index surgery and with a history of normal joint function. RESULTS: 445 patients were included, comprising 340 cases treated with DAIR and 105 cases treated with implant removal (19% one-stage revision (n = 20), 74.3% two-stage revision (n = 78) and 6.7% definitive implant removal (n = 7). Overall failure in patients treated with DAIR was 45.0% (153/340) compared to 24.8% (26/105) for implant removal (p < 0.001). Difference in failure rate remained after 1:1 propensity-score matching. A preoperative CRIME80-score ≥3 (OR 2.9), PJI caused by S. aureus (OR 1.8) and implant retention (OR 3.1) were independent predictors for failure in the multivariate analysis. CONCLUSION: DAIR is a viable surgical treatment for most patients with LA PJI, but implant removal should be considered in a subset of patients, especially in those with a CRIME80-score ≥3.
Authors: T David Tarity; William Xiang; Christopher W Jones; Ioannis Gkiatas; Allina Nocon; Nicolas A Selemon; Alberto Carli; Peter K Sculco Journal: Arthroplast Today Date: 2022-03-02