Martin Thaler1, Ricarda Lechner2, Dietmar Dammerer2, Hermann Leitner3, Ismail Khosravi2, Michael Nogler4. 1. Department of Orthopaedic Surgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. martin.thaler@i-med.ac.at. 2. Department of Orthopaedic Surgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. 3. Institute of Epidemiology, Tirol Kliniken Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria. 4. Department of Orthopaedic Surgery-Experimental Orthopaedics, Medical University Innsbruck, Innrain 36, 6020, Innsbruck, Austria.
Abstract
BACKGROUND: Either one- or two-stage revision arthroplasties can be used for the treatment of chronic periprosthetic joint infection (PJI) after total hip arthroplasty (THA). We report our results following two-stage revision surgery performed through the direct anterior approach (DAA) interval using a custom-made articulating spacer. METHODS: Between 2009 and 2014, 49 patients (49 consecutive procedures) had surgery through either a DAA or extended DAA approach. Each patient received perioperative intravenous administration of antibiotics. A custom-made spacer was implanted after explanting cup and stem and following extensive debridement. Broad-spectrum antibiotics were administered during the immediate perioperative period and then adjusted according to the infecting organism. Complication rates and eradication rates were observed. WOMAC patient assessments were administered preoperatively and one-year postoperatively. RESULTS: Of the 49 study patients, five had a recurrence of the infection after the second-stage revision, five had a proximal periprosthetic fracture during the first stage procedure and one patient had a transient femoral nerve palsy that resolved fully within the first postoperative year. 30 different microorganisms were identified on intraoperative specimens. The average time between first and second stage procedure was 65.7 days (range 21-132 days). Eradication of infection was defined as healed wound without fistula, no drainage, no recurrence of the infection, no subsequent surgical intervention for persistent or perioperative infection after second stage revision and no long-term (> 6 months) antimicrobial suppression therapy. Eradication rate of infection in our study was 89.8%. Postoperative WOMAC scores improved significantly CONCLUSION: The preliminary clinical results for the custom-made spacer technique implanted through the DAA are promising. Therefore, we believe the DAA can be used safely as a standard operative approach for two-stage revision procedures.
BACKGROUND: Either one- or two-stage revision arthroplasties can be used for the treatment of chronic periprosthetic joint infection (PJI) after total hip arthroplasty (THA). We report our results following two-stage revision surgery performed through the direct anterior approach (DAA) interval using a custom-made articulating spacer. METHODS: Between 2009 and 2014, 49 patients (49 consecutive procedures) had surgery through either a DAA or extended DAA approach. Each patient received perioperative intravenous administration of antibiotics. A custom-made spacer was implanted after explanting cup and stem and following extensive debridement. Broad-spectrum antibiotics were administered during the immediate perioperative period and then adjusted according to the infecting organism. Complication rates and eradication rates were observed. WOMAC patient assessments were administered preoperatively and one-year postoperatively. RESULTS: Of the 49 study patients, five had a recurrence of the infection after the second-stage revision, five had a proximal periprosthetic fracture during the first stage procedure and one patient had a transient femoral nerve palsy that resolved fully within the first postoperative year. 30 different microorganisms were identified on intraoperative specimens. The average time between first and second stage procedure was 65.7 days (range 21-132 days). Eradication of infection was defined as healed wound without fistula, no drainage, no recurrence of the infection, no subsequent surgical intervention for persistent or perioperative infection after second stage revision and no long-term (> 6 months) antimicrobial suppression therapy. Eradication rate of infection in our study was 89.8%. Postoperative WOMAC scores improved significantly CONCLUSION: The preliminary clinical results for the custom-made spacer technique implanted through the DAA are promising. Therefore, we believe the DAA can be used safely as a standard operative approach for two-stage revision procedures.
Entities:
Keywords:
Direct anterior approach; Infection; Periprosthetic joint infection; Revision; Total hip arthroplasty
Authors: Boris Michael Holzapfel; Kristoff Corten; Tyler Goldberg; Maximilian Rudert; Michael Nogler; Joseph Moskal; Martin Thaler Journal: Oper Orthop Traumatol Date: 2022-06-09 Impact factor: 1.154
Authors: Martin Thaler; Kristoff Corten; Michael Nogler; Boris Michael Holzapfel; Joseph Moskal Journal: Oper Orthop Traumatol Date: 2022-05-31 Impact factor: 1.286