Abstract
The success rate of prosthesis removal as the standard approach to manage chronic infection in hip arthroplasties (HA) is 80–90 %. The effectiveness of prosthesis retention, with or without surgical debridement, to treat patients with chronic HA infection (symptom duration of more than 4 weeks) has not been well established, whereas this strategy is sometimes used in clinical practice. This study aimed to explore the cumulative incidence of failure of chronic HA infections treated with prosthesis retention, with or without debridement. A systematic literature review was conducted in accordance with the methods described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies concerning patients with chronically infected HA treated with prosthesis retention were included. The primary outcome was the cumulative risk of failure. We searched the MEDLINE, Embase, and Cochrane databases up to April 2014. The database searches provided a total of 1,213 studies for potential inclusion in the review. Six relevant studies were finally identified, corresponding to 29 patients included. Their treatments consisted of prosthesis retention with debridement. This strategy failed for 14 out of these 29 patients after a 1-year follow-up. The failure rate of the prosthesis retention approach associated to debridement for chronic infection in HA is 48.3 % in this review. Debridement and prosthesis retention in association with prolonged antimicrobial treatment may be an advantageous alternative to arthroplasty exchange for frail patients. The difficulty in finding relevant studies illustrates the challenges of interpreting the existing literature for the management of chronic prosthetic joint infection (PJI).
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McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M (2002) Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res 403:8–15
Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM et al (2013) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56(1):e1–e25
Byren I, Bejon P, Atkins BL, Angus B, Masters S, McLardy-Smith P et al (2009) One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother 63(6):1264–1271
Tsukayama DT, Estrada R, Gustilo RB (1996) Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 78(4):512–523
Senneville E, Joulie D, Legout L, Valette M, Dezèque H, Beltrand E et al (2011) Outcome and predictors of treatment failure in total hip/knee prosthetic joint infections due to Staphylococcus aureus. Clin Infect Dis 53(4):334–340
Lange J, Troelsen A, Thomsen RW, Søballe K (2012) Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis. Clin Epidemiol 4:57–73
Beswick AD, Elvers KT, Smith AJ, Gooberman-Hill R, Lovering A, Blom AW (2012) What is the evidence base to guide surgical treatment of infected hip prostheses? systematic review of longitudinal studies in unselected patients. BMC Med 10:18
Romanò CL, Manzi G, Logoluso N, Romanò D (2012) Value of debridement and irrigation for the treatment of peri-prosthetic infections. A systematic review. Hip Int 22(Suppl 8):S19–S24
Betsch BY, Eggli S, Siebenrock KA, Täuber MG, Mühlemann K (2008) Treatment of joint prosthesis infection in accordance with current recommendations improves outcome. Clin Infect Dis 46(8):1221–1226
Aboltins CA, Page MA, Buising KL, Jenney AWJ, Daffy JR, Choong PFM et al (2007) Treatment of staphylococcal prosthetic joint infections with debridement, prosthesis retention and oral rifampicin and fusidic acid. Clin Microbiol Infect 13(6):586–591
Bernard E, Perbost I, Carles M, Michiels A, Carsenti-Etesse H, Chichmanian RM et al (1997) Efficacy and safety of vancomycin constant-rate infusion in the treatment of chronic Gram-positive bone and joint infections. Clin Microbiol Infect 3(4):440–446
Barberán J, Aguilar L, Carroquino G, Giménez M-J, Sánchez B, Martínez D et al (2006) Conservative treatment of staphylococcal prosthetic joint infections in elderly patients. Am J Med 119(11):993.e7–993.e10
Brandt CM, Sistrunk WW, Duffy MC, Hanssen AD, Steckelberg JM, Ilstrup DM et al (1997) Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis 24(5):914–919
Crockarell JR, Hanssen AD, Osmon DR, Morrey BF (1998) Treatment of infection with débridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am 80(9):1306–1313
Tattevin P, Crémieux AC, Pottier P, Huten D, Carbon C (1999) Prosthetic joint infection: when can prosthesis salvage be considered? Clin Infect Dis 29(2):292–295
Marculescu CE, Berbari EF, Hanssen AD, Steckelberg JM, Harmsen SW, Mandrekar JN et al (2006) Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis 42(4):471–478
Legout L, Senneville E (2013) Periprosthetic joint infections: clinical and bench research. ScientificWorldJournal 2013:549091
Zimmerli W, Moser C (2012) Pathogenesis and treatment concepts of orthopaedic biofilm infections. FEMS Immunol Med Microbiol 65(2):158–168
Choi H-R, von Knoch F, Kandil AO, Zurakowski D, Moore S, Malchau H (2012) Retention treatment after periprosthetic total hip arthroplasty infection. Int Orthop 36(4):723–729
Fisman DN, Reilly DT, Karchmer AW, Goldie SJ (2001) Clinical effectiveness and cost-effectiveness of 2 management strategies for infected total hip arthroplasty in the elderly. Clin Infect Dis 32(3):419–430
Merollini KMD, Crawford RW, Graves N (2013) Surgical treatment approaches and reimbursement costs of surgical site infections post hip arthroplasty in Australia: a retrospective analysis. BMC Health Serv Res 13:91
Hernández-Vaquero D, Fernández-Fairen M, Torres A, Menzie AM, Fernández-Carreira JM, Murcia-Mazon A et al (2013) Treatment of periprosthetic infections: an economic analysis. ScientificWorldJournal 2013:821650
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement [Internet]. BMJ 339:b2535. Available online at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714657/. Cited Mar 25 2014
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700
Altman DG (2001) Systematic reviews of evaluations of prognostic variables. BMJ 323(7306):224–228
Kuiper JWP, Brohet RM, Wassink S, van den Bekerom MPJ, Nolte PA, Vergroesen DA (2013) Implantation of resorbable gentamicin sponges in addition to irrigation and debridement in 34 patients with infection complicating total hip arthroplasty. Hip Int 23(2):173–180
Segreti J, Nelson JA, Trenholme GM (1998) Prolonged suppressive antibiotic therapy for infected orthopedic prostheses. Clin Infect Dis 27(4):711–713
Sendi P, Christensson B, Uçkay I, Trampuz A, Achermann Y, Boggian K et al (2011) Group B streptococcus in prosthetic hip and knee joint-associated infections. J Hosp Infect 79(1):64–69
Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ et al (2011) Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 52(3):285–292
Berend KR, Lombardi AV Jr, Morris MJ, Bergeson AG, Adams JB, Sneller MA (2013) Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res 471(2):510–518
Sherrell JC, Fehring TK, Odum S, Hansen E, Zmistowski B, Dennos A et al (2011) The Chitranjan Ranawat Award: fate of two-stage reimplantation after failed irrigation and débridement for periprosthetic knee infection. Clin Orthop Relat Res 469(1):18–25
Gardner J, Gioe TJ, Tatman P (2011) Can this prosthesis be saved?: implant salvage attempts in infected primary TKA. Clin Orthop Relat Res 469(4):970–976
Waldman BJ, Hostin E, Mont MA, Hungerford DS (2000) Infected total knee arthroplasty treated by arthroscopic irrigation and débridement. J Arthroplasty 15(4):430–436
Rao N, Crossett LS, Sinha RK, Le Frock JL (2003) Long-term suppression of infection in total joint arthroplasty. Clin Orthop Relat Res 414:55–60
Cordero-Ampuero J (2012) Girdlestone procedure: when and why. Hip Int 22(Suppl 8):S36–S39
Sharma H, Kakar R (2006) Outcome of Girdlestone’s resection arthroplasty following complications of proximal femoral fractures. Acta Orthop Belg 72(5):555–559
Sharma H, De Leeuw J, Rowley DI (2005) Girdlestone resection arthroplasty following failed surgical procedures. Int Orthop 29(2):92–95
Masters JPM, Smith NA, Foguet P, Reed M, Parsons H, Sprowson AP (2013) A systematic review of the evidence for single stage and two stage revision of infected knee replacement. BMC Musculoskelet Disord 14:222
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Maillet, M., Pavese, P., Bruley, D. et al. Is prosthesis retention effective for chronic infections in hip arthroplasties? A systematic literature review. Eur J Clin Microbiol Infect Dis 34, 1495–1502 (2015). https://doi.org/10.1007/s10096-015-2388-8
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DOI: https://doi.org/10.1007/s10096-015-2388-8