Timing of implant-removal in late acute periprosthetic joint infection: A multicenter observational study.
J Infect
; 79(3): 199-205, 2019 09.
Article
em En
| MEDLINE
| ID: mdl-31319141
ABSTRACT
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 (nâ¯=â¯20), 74.3% two-stage revision (nâ¯=â¯78) and 6.7% definitive implant removal (nâ¯=â¯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 11 propensity-score 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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Próteses e Implantes
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Artrite Infecciosa
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Infecções Relacionadas à Prótese
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Remoção de Dispositivo
Tipo de estudo:
Diagnostic_studies
/
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
/
Humans
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Male
Idioma:
En
Revista:
J Infect
Ano de publicação:
2019
Tipo de documento:
Article