Timing of implant-removal in late acute periprosthetic joint infection: A multicenter observational study

Objectives: We evaluated the treatment outcome in late acute (LA) periprosthetic joint infections (PJI) treated with debridement and implant retention (DAIR) versus implant removal. Methods: In a large multicenter study, LA PJIs of the hip and knee were retrospectively evaluated. Failure was defined...

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Detalles Bibliográficos
Autores: Wouthuyzen-Bakker, M, Sebillotte, M, Lomas, J, Kendrick, B, Palomares, EB, Murillo, O, Parvizi, J, Shohat, N, Reinoso, JC, Sanchez, RE, Fernandez-Sampedro, M, Senneville, E, Huotari, K, Allende, JMB, Garcia, AB, Lora-Tamayo, J, Ferrari, MC, Vaznaisiene, D, Yusuf, E, Aboltins, C, Trebse, R, Salles, MJ, Benito, N, Vila, A, Del Toro, MD, Kramer, TS, Petersdorf, S, Diaz-Brito, V, Tufan, ZK, Sanchez, M, Arvieux, C, Soriano, A, Gougeon, A, Common, H, Meheut, A, Gomez-Junyent, J, Tarabichi, M, Demirturk, A, Ribeiro, T, Honda, E, Polesello, G, Jutte, P, Ploegmakers, J, Lowik, C, Bori, G, Morata, L, Lozano, L, Mancheno, M, Chaves, F, Smolders, D, Inthavong, P, Taylor, A, Digumber, M, Pfang, BG, Tornero, E, Moreno, E, Noth, U, Rivero, C, Coll, P, Crusi, X, Mur, I, Dapas, J, Tattevin, P, Esteban, J, Garcia-Canete, J, Scarborough, M
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p2468
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2468
https://hdl.handle.net/11370/dcebddac-f845-465d-8532-ea90644c0956
Access Level:acceso abierto
Palabra clave:Periprosthetic joint infection
Late acute
Hematogenous
Debridement
Revision surgery
Failure
Descripción
Sumario:Objectives: We evaluated the treatment outcome in late acute (LA) periprosthetic joint infections (PJI) treated with debridement and implant retention (DAIR) versus implant removal. Methods: In a large multicenter study, LA PJIs of the hip and knee were retrospectively evaluated. Failure was defined as: PJI related death, prosthesis removal or the need for suppressive antibiotic therapy. LA PJI was defined as acute symptoms <3 weeks in patients more than 3 months after the index surgery and with a history of normal joint function. Results: 445 patients were included, comprising 340 cases treated with DAIR and 105 cases treated with implant removal (19% one-stage revision (n = 20), 74.3% two-stage revision (n = 78) and 6.7% definitive implant removal (n = 7). Overall failure in patients treated with DAIR was 45.0% (153/340) compared to 24.8% (26/105) for implant removal (p < 0.001). Difference in failure rate remained after 1: 1 propensityscore matching. A preoperative CRIME80-score >= 3 (OR 2.9), PJI caused by S. aureus (OR 1.8) and implant retention (OR 3.1) were independent predictors for failure in the multivariate analysis. Conclusion: DAIR is a viable surgical treatment for most patients with LA PJI, but implant removal should be considered in a subset of patients, especially in those with a CRIME80-score >= 3. (C) 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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