Date Published: June 4, 2012
Publisher: Informa Healthcare
Author(s): Marianne Westberg, Bjarne Grøgaard, Finnur Snorrason.
Debridement and retention of the prosthesis is often attempted to treat early prosthetic joint infection (PJI). However, previous studies have found inconsistent results, with success rates ranging from 21% to 100%, and little has been written in the literature about hip function. We have therefore analyzed the clinical and functional outcome of early PJIs treated with this procedure.
38 patients with early PJI after primary hip arthroplasty who were treated with debridement and retention of the implant between 1998 and 2005 were studied prospectively, with a median follow-up time of 4 (0.8–10) years. Early infection was defined as that which occurred within 4 weeks of index arthroplasty. The primary outcome measure was infection control. Functional outcome was assessed with the Harris hip score.
27 of 38 patients were successfully treated, with no signs of infection or continued antibiotic treatment at the latest follow-up. Median Harris hip score was 86 (47–100) points. In 9 of the 11 patients for whom treatment failed, infection was successfully treated with 1-stage or 2-stage reimplantation or resection. Intraoperative cultures were positive in 36 hips, and the most frequently isolated organisms were Staphylococcus aureus and coagulase-negative staphylococci (CoNS). 15 infections were polymicrobial, and only 8 of them were successfully treated with debridement and retention of the implant.
Our data suggest that debridement and retention of the prosthesis is a reasonable treatment option in early PJI after primary hip arthroplasty, with satisfactory functional results.
All primary total hip replacements (THRs) at our center were prospectively recorded as part of a quality registration between January 1998 and December 2005. We studied the early PJIs in this THR cohort. PJI was classified as being early when symptoms presented less than 4 weeks after arthroplasty, according to Segawa and Tsukayama (Tsukayama et al. 1996). Infection was diagnosed clinically and was based on the CDC definition of deep incisional surgical site infection (Mangram et al. 1999). 8 biopsies and joint aspirates were taken perioperatively, and a minimum of 2 tissue specimens had to be positive before we regarded the organism isolated as being the infecting organism.
Our main finding was favorable outcome after debridement and retention of the prosthesis in early PJIs after primary THR. Patients who were treated successfully had a satisfactory functional outcome with a median Harris hip score of 86 points at the latest follow-up. Moreover, we found a high rate of polymicrobial infections with a tendency of poorer outcome.