Enrick Castanet1,2, Pierre Martinot3,4,5, Julien Dartus1,2, Eric Senneville1,2,6, Henri Migaud1,2, Julien Girard1,2. 1. Univ Lille, Hauts de France, 59000, Lille, France. 2. Orthopaedics Department, Hôpital Salengro, CHU Lille, Place de Verdun, 59000, Lille, France. 3. Univ Lille, Hauts de France, 59000, Lille, France. pierre.martinot@hotmail.fr. 4. Orthopaedics Department, Hôpital Salengro, CHU Lille, Place de Verdun, 59000, Lille, France. pierre.martinot@hotmail.fr. 5. Hôpital Salengro, CHRU de Lille, Service d'Orthopédie 2Place de Verdun, 59037, Lille, France. pierre.martinot@hotmail.fr. 6. Infectious Diseases Department, Gustave Dron Hospital, 59200, Tourcoing, France.
Abstract
INTRODUCTION: The management of prosthetic joint infection (PJI) has been widely studied in the context of total hip arthroplasty (THA). However, the outcomes of debridement, antibiotics and implant retention (DAIR) for PJI have never been compared between hip resurfacing arthroplasty (HRA) and THA. This led us to carry out a retrospective case-control study comparing the surgical treatment of post-operative infections between HRA and THA to determine the infection remission rate and the medium-term functional outcomes. METHODS: This single-centre case-control study analysed 3056 HRA cases of which 13 patients had a PJI treated by DAIR. These patients were age-matched with 15 infected THA hips treated by DAIR and modular component exchange (controls). Their survival (no recurrence of the infection) was compared and factors that could affect the success of the DAIR were explored: sex, body mass index, age at surgery, presence of haematoma, type of bacteria present and antibiotic therapy. RESULTS: At a mean follow-up of five years (2-7), the infection control rate was significantly higher in the HRA group (100% [13/13]) than in the THA group (67% [10/15]) (p = 0.044). More patients in the THA group had undergone early DAIR (< 30 days) (73% [11/15]) than in the HRA group (54% [7/13]). There was no significant difference between the two groups in the ASA score, presence of comorbidities, body mass index and duration of the initial arthroplasty procedure. At the review, the Oxford-12 score of 17/60 (12-28) was better in the HRA group than the score of 25/60 (12-40) in the THA group (p = 0.004). CONCLUSION: DAIR, no matter the time frame, is a viable therapeutic option for infection control after HRA.
INTRODUCTION: The management of prosthetic joint infection (PJI) has been widely studied in the context of total hip arthroplasty (THA). However, the outcomes of debridement, antibiotics and implant retention (DAIR) for PJI have never been compared between hip resurfacing arthroplasty (HRA) and THA. This led us to carry out a retrospective case-control study comparing the surgical treatment of post-operative infections between HRA and THA to determine the infection remission rate and the medium-term functional outcomes. METHODS: This single-centre case-control study analysed 3056 HRA cases of which 13 patients had a PJI treated by DAIR. These patients were age-matched with 15 infected THA hips treated by DAIR and modular component exchange (controls). Their survival (no recurrence of the infection) was compared and factors that could affect the success of the DAIR were explored: sex, body mass index, age at surgery, presence of haematoma, type of bacteria present and antibiotic therapy. RESULTS: At a mean follow-up of five years (2-7), the infection control rate was significantly higher in the HRA group (100% [13/13]) than in the THA group (67% [10/15]) (p = 0.044). More patients in the THA group had undergone early DAIR (< 30 days) (73% [11/15]) than in the HRA group (54% [7/13]). There was no significant difference between the two groups in the ASA score, presence of comorbidities, body mass index and duration of the initial arthroplasty procedure. At the review, the Oxford-12 score of 17/60 (12-28) was better in the HRA group than the score of 25/60 (12-40) in the THA group (p = 0.004). CONCLUSION: DAIR, no matter the time frame, is a viable therapeutic option for infection control after HRA.
Authors: Donna M Urquhart; Fahad S Hanna; Sharon L Brennan; Anita E Wluka; Karin Leder; Peter A Cameron; Stephen E Graves; Flavia M Cicuttini Journal: J Arthroplasty Date: 2009-10-30 Impact factor: 4.757
Authors: Steven M Kurtz; Edmund Lau; Kevin Ong; Ke Zhao; Michael Kelly; Kevin J Bozic Journal: Clin Orthop Relat Res Date: 2009-04-10 Impact factor: 4.176
Authors: Håvard Dale; Anne M Fenstad; Geir Hallan; Leif I Havelin; Ove Furnes; Søren Overgaard; Alma B Pedersen; Johan Kärrholm; Göran Garellick; Pekka Pulkkinen; Antti Eskelinen; Keijo Mäkelä; Lars B Engesæter Journal: Acta Orthop Date: 2012-10 Impact factor: 3.717