A mean 4-year evaluation of infection control rates of hip and knee prosthetic joint infection-related revision arthroplasty: an observational study

Bruce van Dijk; F Ruben H A Nurmohamed; J Fred F Hooning van Duijvenbode; Ewout S Veltman; Rob J Rentenaar; Harrie Weinans; H Charles Vogely; Bart C H van der Wal

doi:10.2340/17453674.2022.3975

Authors

Bruce van Dijk Department of Orthopedics, University Medical Center Utrecht, Utrecht
F Ruben H A Nurmohamed Department of Orthopedics, University Medical Center Utrecht, Utrecht https://orcid.org/0000-0001-5369-9853
J Fred F Hooning van Duijvenbode Department of Orthopedics, University Medical Center Utrecht, Utrecht
Ewout S Veltman Department of Orthopedics, University Medical Center Utrecht, Utrecht https://orcid.org/0000-0001-6334-0967
Rob J Rentenaar Department of Medical Microbiology, University Medical Center Utrecht, Utrecht https://orcid.org/0000-0003-3513-5936
Harrie Weinans Department of Orthopedics, University Medical Center Utrecht, Utrecht; Department of Biomechanical Engineering, TU Delft, Delft, The Netherlands
H Charles Vogely Department of Orthopedics, University Medical Center Utrecht, Utrecht
Bart C H van der Wal Department of Orthopedics, University Medical Center Utrecht, Utrecht

DOI:

https://doi.org/10.2340/17453674.2022.3975

Keywords:

arthroplasty, infection, one stage revision, periprosthetic joint infection, PJI, two stage revision

Abstract

Background and purpose: The long-term results of the 1- or 2-stage revision procedure and infection-free prosthesis survival in a tertiary referral center are unknown. In this retrospective observational study, the long-term results of infection control and infection-free prosthesis survival of the periprosthetic joint infection-related 1- and 2-stage revision procedure are evaluated. Furthermore, the merits of performing an antibiotic-free window in the 2-stage revision is evaluated.
Patients and methods: All patients who received a 1- or 2-stage revision procedure of the hip or knee between 2010 and 2017 were included. Data was collected on patient and infection characteristics. The primary treatment aim was successful infection control without the use of antibiotic therapy afterwards. Infection-free survival analysis was performed using the Kaplan–Meier method with type of periprosthetic joint infection-related revision as covariate. Within the group of 2-stage revisions, use of an antibioticfree window was selected as covariate.
Results: 128 patients were treated for a periprosthetic joint infection-related revision procedure (81 hips and 47 knees). Successful infection control was achieved in 18 of 21 cases for the 1-stage and 89 out of 107 cases for the 2-stage revision procedure (83%) respectively after follow-up of more than 4 years. In addition, 2-stage revision procedure infection control was achieved in 52 of 60 cases with an antibiotic-free interval and 37 of 45 cases without such interval (p = 0.6). The mean infection-free survival of the 1-stage
revision was 90 months (95% CI 75–105) and 98 months (CI 90–106) for the 2-stage revision procedure.
Interpretation: There seems to be no difference in infection control and infection-free survival between the 1- and 2-stage revision procedure. Second, an antibiotic-free window in the case of a 2-stage revision did not seem to influence treatment outcome. However, one must be cautious when interpreting these results due to confounding by indication and the small study population. Therefore, no definite conclusion can be drawn.