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Long Term Results of Two-Stage Revision for Chronic Periprosthetic Hip Infection: A Multicenter Study

Journal of Clinical Medicine, ISSN: 2077-0383, Vol: 11, Issue: 6
2022
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Does a DAIR procedure or staged revision surgery provide better outcomes for PJI?

Click here to read the Cover Story, "Multidisciplinary teams crucial for joint infection treatment." PJI is a dreaded complication of primary and revision total joint arthroplasty, with an estimated incidence of 1% to 2% in primary arthroplasty and up to 10% in revision procedures. The occurrence of PJI has been found to be associated with an increased risk of mortality and morbidity in both total

Article Description

Background: Two-stage exchange arthroplasty remains the gold standard in the United States for treatment of chronic periprosthetic joint infection (PJI). Long-term reinfection rates and clinical outcomes with sufficient subject numbers remain limited. The purpose was to evaluate the long-term outcomes following two-stage exchange following hip arthroplasty. Methods: Retrospective review of 221 patients who underwent two-stage exchange hip arthroplasty for chronic PJI at three large tertiary referral institutions from 1990–2015. Outcomes including reinfection, mortality, and all-cause revision were calculated. Cumulative incidence of reinfection with death as competing factor was also calculated. Risk factors for reinfection were determined using Cox multivariate re-gression analysis. Results: Rate of infection eradication and all-cause revision was 88.24% and 22.6%, respectively. Overall mortality rate was 40.72%. Patients with minimum five-year follow-up (n = 129) had a success rate of 91.47% with mortality rate of 41.1%. Major risk factors for reinfection included polymicrobial infection (HR = 2.36, 95% CI: 1.08–5.14) and antibiotic resistant organism (HR = 2.36, 95% CI: 1.10–5.04). Conclusion: This is the largest series with greater than 5-year follow-up evaluat-ing outcomes of two-stage exchange hip arthroplasty. This technique resulted in a relatively high infection eradication, however, the mortality rate is alarmingly high. Antibiotic resistant organisms appear to be highest risk factor for failure.

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