Treatment of joint prosthesis infection in accordance with current recommendations improves outcome.
BACKGROUND
Recently recommended treatment modalities for prosthetic joint infection (PJI) were evaluated.


METHODS
A retrospective cohort analysis of 68 patients with PJI of hip or knee who were treated from 1995 through 2004 was conducted at the University Hospital Bern (Bern, Switzerland).


RESULTS
A 2-stage exchange was the most frequent (75.0%) surgical strategy, followed by retention and debridement (17.6%), 1-stage exchange (5.9%), and resection arthroplasty or suppressive antimicrobial treatment (1.5%). The chosen strategy was in 88% agreement with the recommendations. Adherence was only 17% for retention and debridement and was 0% for 1-stage exchange. Most PJIs (84%) were treated with an adequate or partially adequate antimicrobial regimen. Recurrence-free survival was observed in 51.5% of PJI episodes after 24 months of follow-up. The risk of treatment failure was significantly higher for PJI treated with a surgical strategy other than that recommended (hazard ratio, 2.34; 95% confidence interval, 1.10-4.70; P = .01) and for PJIs treated with antibiotics not corresponding to recommendations (hazard ratio, 3.45; confidence interval, 1.50-7.60; P = .002). Other risk factors associated with lack of healing were a high infection score at the time of diagnosis (hazard ratio, 1.29; 95% confidence interval, 1.10-1.40; P < .001) and presence of a sinus tract (hazard ratio, 2.35; 95% confidence interval, 1.10-5.0; P = .02).


CONCLUSIONS
Our study demonstrates the value of current treatment recommendations. Inappropriate choice of conservative surgical strategies (such as debridement and retention) and inadequate antibiotic treatment are associated with failure.
Betsch
Belinda Y
BY
Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland.
Eggli
Stefan
S
Siebenrock
Klaus A
KA
Täuber
Martin G
MG
Mühlemann
Kathrin
K
D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019643:Arthroplasty, Replacement / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006622:Hip Prosthesis / Q000382:microbiology; D006801:Humans; D007595:Joint Prosthesis / Q000382:microbiology*; D007720:Knee Prosthesis / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000890:Anti-Infective Agents