Author(s): Elie Ghanem*, Fereidoon Jaberi, Camilo Restrepo ,Adriana Rodriguez-Paez, Javad Parvizi; Rothman Institute,Philadelphia, PA
Title: Periprosthetic Infection: Are Current Strategies for Treatment Adequate?
Purpose: Currently two-stage resection arthroplasty is the preferred method for surgical treatment of periprosthetic infection in North America. The purpose of this study was to determine the efficacy of this treatment modality in infection.
Methods: During the period of this study (2000-2005) 77 patients with an infected THA were treated at our institution. 54 patients underwent two-stage exchange arthroplasty while the remaining 22 failed to have the second stage reimplantation due to ill health. The latter 22 were excluded from the analysis. All patients were followed up prospectively for at least two years after reimplantation. Detailed data including demographics, comorbidities, surgical history, and medication intake was collected. Intraoperative data, organism profile, and complications were also documented. Failure was defined as patient requiring additional surgical procedure for control of infection or loosening.
Results: Two-stage exchange arthroplasty successfully eradicated infection in 36 patients (67%) without need for further treatment. 7 patients (13%) had recurrent infection that necessitated resection arthroplasty. 11 (20%) patients required irrigation and debridement for postoperative purulent drainage which successfully treated infection in 8 of the cases. The remaining 3 patients failed and required resection arthroplasty. 3 additional patients had early loosening of components and required revision arthroplasty. Our multivariate analysis identified a higher comorbidities (OR: 13.1), and infection with methicillin-resistant organisms (OR: 3.7) as risk factors for failure.
Discussion: Current strategies to treat periprosthetic infection remain imperfect. Two-stage exchange arthroplasty with all its inherent problems and inconveniences imparted a modest success in treatment of PPI at our high volume specialized center. With the increase in the number of virulent and resistant organisms, arthoplasties being performed in the highly comorbid patient infirm the success of this procedure is likely to decline further. Hence, novel strategies for treatment of PPI are desperately needed.