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

Bejon P, Berendt A, Atkins BL, Green N, Parry H, Masters S, McLardy-Smith P, Gundle R, Byren I - J. Antimicrob. Chemother. (2010)

Bottom Line: 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].Furthermore, most unplanned debridements following the first stage were carried out before antibiotics were stopped (25 versus 2 debridements).Re-revision was associated with a significantly worse outcome.

View Article: PubMed Central - PubMed

Affiliation: Bone Infection Unit, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK. pbejon@well.ox.ac.uk

ABSTRACT

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.

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Related in: MedlinePlus

Kaplan–Meier plot showing survival of implants by older (≥70 years) versus younger (<70 years) patient age.
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DKP469F1: Kaplan–Meier plot showing survival of implants by older (≥70 years) versus younger (<70 years) patient age.

Mentions: The survival plots of the two factors that remained significant on multivariate analysis show that patient age may have a constant effect over time (Figure 1), but that the effect of previous revisions on implant survival is mostly mediated in the first 6 months (Figure 2).


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

Bejon P, Berendt A, Atkins BL, Green N, Parry H, Masters S, McLardy-Smith P, Gundle R, Byren I - J. Antimicrob. Chemother. (2010)

Kaplan–Meier plot showing survival of implants by older (≥70 years) versus younger (<70 years) patient age.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2818105&req=5

DKP469F1: Kaplan–Meier plot showing survival of implants by older (≥70 years) versus younger (<70 years) patient age.
Mentions: The survival plots of the two factors that remained significant on multivariate analysis show that patient age may have a constant effect over time (Figure 1), but that the effect of previous revisions on implant survival is mostly mediated in the first 6 months (Figure 2).

Bottom Line: 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].Furthermore, most unplanned debridements following the first stage were carried out before antibiotics were stopped (25 versus 2 debridements).Re-revision was associated with a significantly worse outcome.

View Article: PubMed Central - PubMed

Affiliation: Bone Infection Unit, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK. pbejon@well.ox.ac.uk

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus