Characterization of Outcomes of 2-Stage Exchange Arthroplasty in the Treatment of Prosthetic Joint Infections.

BACKGROUND: Two-stage revision is the preferred treatment for prosthetic hip and knee infections in the United States. Recent studies have questioned the true success rate of this treatment. The purpose of this study is to investigate outcomes of prosthetic hip and knee infections undergoing resection arthroplasty and spacer insertion at a single institution. METHODS: We identified 103 patients who underwent prosthesis resection and spacer placement for infection over a 10-year period. Twenty-three cases were excluded based on preset exclusion criteria leaving 80 cases (56 knees, 24 hips). A retrospective review was performed to examine the outcomes of these patients. RESULTS: Following spacer placement but before reimplantation, 9 (11.25%) of the 80 joints underwent repeat debridement and spacer exchange for persistent infection. Twenty-four (30.00%) patients had a serious complication during their treatment course. Fourteen (17.50%) patients never underwent reimplantation. Of these, 10 continued with spacer retention, 2 had resection arthroplasty, and 1 each had an amputation and an arthrodesis. Of the 66 patients with successful reimplantation, 48 (72.70%) remained infection free at most recent follow-up. CONCLUSIONS: Two-stage revision does not result in the high rates of cure reported previously, when taking into account the substantial number of patients who never undergo the subsequent reimplantation surgery. Of those who underwent reimplantation in our study, many required additional spacer exchange or had complications. Surgeons and patients should consider these outcomes when discussing the treatment of prosthetic hip and knee infections.

Management of Periprosthetic Hip and Knee Joint Infections With a Known Sinus Tract-A Single-Center Experience.

BACKGROUND: Prosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). A sinus tract communicating with a prosthetic joint is a major criterion defining PJI. Despite this fact, many patients presenting with a draining sinus tract undergo invasive procedures before initiation of two-stage revision arthroplasty. We hypothesized that many patients undergo nondefinitive procedures to treat the sinus tract, rather than undergoing definitive treatment of infection with two-stage revision. METHODS: A retrospective review of all cases of two-stage revision arthroplasty at Loyola University Medical Center between January 2004 and May 2018 was performed. Patients with infected TJA and periprosthetic sinus tract were included. Records were queried for laboratory values and prior procedures. RESULTS: We identified 160 patients who underwent two-stage revision for infection over the 14-year period. Of the 160 patients, 25 had a documented periprosthetic sinus tract before initiation of definitive revision arthroplasty and were included. Eleven (44.0%) had one or more procedures including interventional radiology drain placement, local wound care, or formal irrigation and debridement before definitive treatment. Forty-five percent of patients that underwent nondefinitive procedures before definitive surgery had either an erythrocyte sedimentation rate or C-reactive protein at normal or near-normal levels. CONCLUSION: Many arthroplasty patients presenting with periprosthetic sinus tracts undergo nondefinitive procedures before definitive treatment. Inherent surgical risks of these procedures can increase the overall morbidity and mortality of these patients. Further effort is needed to educate surgeons regarding management of sinus tracts after TJA.