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Characteristics and treatment outcomes of 69 cases with early prosthetic joint infections of the hip and knee

Achermann, Y. ; Stasch, P. ; Preiss, S. ; Lucke, K. ; Vogt, M.

In: Infection, 2014, vol. 42, no. 3, p. 511-519

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    Titre
    • Characteristics and treatment outcomes of 69 cases with early prosthetic joint infections of the hip and knee
    Auteur
    • Achermann, Y.. Department of Microbial Pathogenesis, Dental School, University of Maryland, 650 W. Baltimore Street, 21201, Baltimore, MD, USA
    • Stasch, P.. Infectious Diseases Service, Department of Internal Medicine, Cantonal Hospital Zug, 6340, Baar, Switzerland
    • Preiss, S.. Schulthess Clinic, 8008, Zurich, Switzerland
    • Lucke, K.. Microbiology Laboratory, Unilabs, 8008, Zurich, Switzerland
    • Vogt, M.. Infectious Diseases Service, Department of Internal Medicine, Cantonal Hospital Zug, 6340, Baar, Switzerland
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:325275
    Summary
    Purpose: Early prosthetic joint infection (PJI) can be treated with an intensive surgical debridement and implant retention (DAIR) of the prosthesis if (1) the prosthesis is stable, (2) the pathogen is not a difficult-to-treat microorganism, (3) symptoms have lasted for <3weeks and (4) a sinus tract is absent. Methods: We retrospectively evaluated the treatment outcome of early PJI in the hip and knee in a single orthopaedic centre. An early PJI was defined as a prosthesis infection within 3months after primary implantation or revision surgery for a non-infectious cause. Results: We identified 69 patients with confirmed early PJI, with a median age of 71 (range 33-84) years. Only 64% presented with ≥2 acute signs of infection. The most commonly isolated bacteria were coagulase-negative staphylococci (38%) and Staphylococcus aureus (25%). Surgical procedures included DAIR (50 cases, 69%) and two-stage exchange (19 cases, 31%). At last follow-up, five ofremaining living 67 patients (7.5%) had a relapse of infection. The overall relapse-free survival of the prosthesis after 2 yearswas 92.3% (95% confidence interval 82-97%) with no significant difference between DAIR and exchange of prosthesis. Conclusion: Our data suggest that an early PJI should be treated with DAIR as a less invasive procedure whenever possible according to the established treatment algorithm.