Repeat two-stage exchange arthroplasty for prosthetic hip re-infection

T. S. Brown, K. A. Fehring, M. Ollivier, T. M. Mabry, A. D. Hanssen, Matthew Abdel

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aims: Recurrent infection following two-stage revision total hip arthroplasty (THA) for prosthetic joint infection (PJI) is a devastating complication. The purpose of this study was to report the survival of repeat two-stage revision hip arthroplasty, describe complications, and identify risk factors for failure. Patients and Methods: We retrospectively identified 19 hips (19 patients) that had undergone repeat two-stage revision THA for infection between 2000 to 2013. There were seven female patients (37%) and the mean age was 60 years (30 to 85). Survival free from revision was assessed via Kaplan-Meier analysis. The patients were classified according to the Musculoskeletal Infection Society (MSIS) system, and risk factors for failure were identified. Mean follow-up was four years (2 to 11). Results: Gram-positive bacteria were responsible for 16/17 (94%) of the re-infections where microbes were identified. Following the repeat two-stage exchange arthroplasty, survival free from any revision was 74% (95% confidence interval (CI) 56% to 96%, 14 at risk) at two years and 45% (95% CI 25% to 75%, five at risk) at five years. Failure to control infection resulted in re-operation or revision in 42% of patients (8/19). Survival free from revision was not dependent on host grade. Conclusion: Re-infection after two-stage exchange hip arthroplasty for PJI presents a challenging scenario. Repeat two-stage exchange arthroplasty has a low survival free from revision at five years (45%) and a high rate of re-infection (42%).

Original languageEnglish (US)
Pages (from-to)1157-1161
Number of pages5
JournalBone and Joint Journal
Volume100B
Issue number9
DOIs
StatePublished - Sep 1 2018

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Arthroplasty
Hip
Infection
Survival
Joints
Confidence Intervals
Kaplan-Meier Estimate
Gram-Positive Bacteria
Infection Control

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Repeat two-stage exchange arthroplasty for prosthetic hip re-infection. / Brown, T. S.; Fehring, K. A.; Ollivier, M.; Mabry, T. M.; Hanssen, A. D.; Abdel, Matthew.

In: Bone and Joint Journal, Vol. 100B, No. 9, 01.09.2018, p. 1157-1161.

Research output: Contribution to journalArticle

Brown, T. S. ; Fehring, K. A. ; Ollivier, M. ; Mabry, T. M. ; Hanssen, A. D. ; Abdel, Matthew. / Repeat two-stage exchange arthroplasty for prosthetic hip re-infection. In: Bone and Joint Journal. 2018 ; Vol. 100B, No. 9. pp. 1157-1161.
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abstract = "Aims: Recurrent infection following two-stage revision total hip arthroplasty (THA) for prosthetic joint infection (PJI) is a devastating complication. The purpose of this study was to report the survival of repeat two-stage revision hip arthroplasty, describe complications, and identify risk factors for failure. Patients and Methods: We retrospectively identified 19 hips (19 patients) that had undergone repeat two-stage revision THA for infection between 2000 to 2013. There were seven female patients (37{\%}) and the mean age was 60 years (30 to 85). Survival free from revision was assessed via Kaplan-Meier analysis. The patients were classified according to the Musculoskeletal Infection Society (MSIS) system, and risk factors for failure were identified. Mean follow-up was four years (2 to 11). Results: Gram-positive bacteria were responsible for 16/17 (94{\%}) of the re-infections where microbes were identified. Following the repeat two-stage exchange arthroplasty, survival free from any revision was 74{\%} (95{\%} confidence interval (CI) 56{\%} to 96{\%}, 14 at risk) at two years and 45{\%} (95{\%} CI 25{\%} to 75{\%}, five at risk) at five years. Failure to control infection resulted in re-operation or revision in 42{\%} of patients (8/19). Survival free from revision was not dependent on host grade. Conclusion: Re-infection after two-stage exchange hip arthroplasty for PJI presents a challenging scenario. Repeat two-stage exchange arthroplasty has a low survival free from revision at five years (45{\%}) and a high rate of re-infection (42{\%}).",
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N2 - Aims: Recurrent infection following two-stage revision total hip arthroplasty (THA) for prosthetic joint infection (PJI) is a devastating complication. The purpose of this study was to report the survival of repeat two-stage revision hip arthroplasty, describe complications, and identify risk factors for failure. Patients and Methods: We retrospectively identified 19 hips (19 patients) that had undergone repeat two-stage revision THA for infection between 2000 to 2013. There were seven female patients (37%) and the mean age was 60 years (30 to 85). Survival free from revision was assessed via Kaplan-Meier analysis. The patients were classified according to the Musculoskeletal Infection Society (MSIS) system, and risk factors for failure were identified. Mean follow-up was four years (2 to 11). Results: Gram-positive bacteria were responsible for 16/17 (94%) of the re-infections where microbes were identified. Following the repeat two-stage exchange arthroplasty, survival free from any revision was 74% (95% confidence interval (CI) 56% to 96%, 14 at risk) at two years and 45% (95% CI 25% to 75%, five at risk) at five years. Failure to control infection resulted in re-operation or revision in 42% of patients (8/19). Survival free from revision was not dependent on host grade. Conclusion: Re-infection after two-stage exchange hip arthroplasty for PJI presents a challenging scenario. Repeat two-stage exchange arthroplasty has a low survival free from revision at five years (45%) and a high rate of re-infection (42%).

AB - Aims: Recurrent infection following two-stage revision total hip arthroplasty (THA) for prosthetic joint infection (PJI) is a devastating complication. The purpose of this study was to report the survival of repeat two-stage revision hip arthroplasty, describe complications, and identify risk factors for failure. Patients and Methods: We retrospectively identified 19 hips (19 patients) that had undergone repeat two-stage revision THA for infection between 2000 to 2013. There were seven female patients (37%) and the mean age was 60 years (30 to 85). Survival free from revision was assessed via Kaplan-Meier analysis. The patients were classified according to the Musculoskeletal Infection Society (MSIS) system, and risk factors for failure were identified. Mean follow-up was four years (2 to 11). Results: Gram-positive bacteria were responsible for 16/17 (94%) of the re-infections where microbes were identified. Following the repeat two-stage exchange arthroplasty, survival free from any revision was 74% (95% confidence interval (CI) 56% to 96%, 14 at risk) at two years and 45% (95% CI 25% to 75%, five at risk) at five years. Failure to control infection resulted in re-operation or revision in 42% of patients (8/19). Survival free from revision was not dependent on host grade. Conclusion: Re-infection after two-stage exchange hip arthroplasty for PJI presents a challenging scenario. Repeat two-stage exchange arthroplasty has a low survival free from revision at five years (45%) and a high rate of re-infection (42%).

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