Two-stage revision for prosthetic joint infection: predictors of outcome and the role of reimplantation microbiology

Objectives We describe rates of success for two-stage revision of prosthetic joint infection (PJI), including data on reimplantation microbiology. Methods We retrospectively collected data from all the cases of PJI that were managed with two-stage revision over a 4 year period. Patients were managed...

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Bibliographic Details
Published in:Journal of antimicrobial chemotherapy 2010-03, Vol.65 (3), p.569-575
Main Authors: Bejon, P., Berendt, A., Atkins, B. L., Green, N., Parry, H., Masters, S., Mclardy-Smith, P., Gundle, R., Byren, I.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
antibiotic
Antibiotics
Antibiotics. Antiinfectious agents. Antiparasitic agents
Biological and medical sciences
complications
Diseases of the osteoarticular system
Drug therapy
Female
Humans
infected arthroplasty
Infections
Joint Diseases - drug therapy
Joint Diseases - surgery
Joints
Male
Medical sciences
Microbiology
Middle Aged
Miscellaneous. Osteoarticular involvement in other diseases
Original Research
Pharmacology. Drug treatments
Prostheses
Prosthesis-Related Infections - drug therapy
Prosthesis-Related Infections - surgery
re-revision
Replantation
Retrospective Studies
Treatment Outcome
Young Adult
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Summary:Objectives We describe rates of success for two-stage revision of prosthetic joint infection (PJI), including data on reimplantation microbiology. Methods We retrospectively collected data from all the cases of PJI that were managed with two-stage revision over a 4 year period. Patients were managed with an antibiotic-free period before reimplantation, in order to confirm, clinically and microbiologically, that infection was successfully treated. Results One hundred and fifty-two cases were identified. The overall success rate (i.e. retention of the prosthesis over 5.75 years of follow-up) was 83%, but was 89% for first revisions and 73% for re-revisions [hazard ratio = 2.9, 95% confidence interval (CI) 1.2–7.4, P = 0.023]. Reimplantation microbiology was frequently positive (14%), but did not predict outcome (hazard ratio = 1.3, 95% CI 0.4–3.7, P = 0.6). Furthermore, most unplanned debridements following the first stage were carried out before antibiotics were stopped (25 versus 2 debridements). Conclusions We did not identify evidence supporting the use of an antibiotic-free period before reimplantation and routine reimplantation microbiology. Re-revision was associated with a significantly worse outcome.
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkp469