title: The preoperative prediction of success following irrigation and debridement with polyethylene exchange for hip and knee prosthetic joint infections.
abstract: Although the criterion standard for the treatment of prosthetic joint infections (PJIs) is 2-stage revision with interim placement of an antibiotic-loaded spacer, irrigation and debridement with polyethylene exchange offer advantages such as fewer surgeries, reduced potential for intraoperative complications, and lower direct costs. The purpose of this study was to develop a tool to preoperatively predict the probability of successful infection eradication following irrigation and debridement with polyethylene exchange for hip or knee PJIs. A total of 10,411 surgical cases were retrospectively reviewed, and data were collected from 309 charts. Overall, 149 (48.2%) cases failed to eradicate the infection following irrigation and debridement with polyethylene exchange. Univariate analysis identified multiple variables independently associated with reinfection including duration of symptoms, preoperative inflammatory markers, and infecting organism. Logistic regression was used to generate a model (bootstrap-corrected concordance index of 0.645) to predict successful eradication of the infection, which was the basis for a nomogram. Using commonly obtained preoperative variables, the nomogram can be used to predict the probability of infection-free survival at 1, 2, 3, 4, and 5 years. Preoperative knowledge of the probability that a treatment strategy will eradicate a patient's PJI may improve risk assessment.
authors.affiliation: Department of Orthopaedic Surgery-A41, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
authors.forename: Leonard T
authors.initials: LT
authors.lastname: Buller
authors.forename: Fady Youssef
authors.initials: FY
authors.lastname: Sabry
authors.forename: Robert W
authors.initials: RW
authors.lastname: Easton
authors.forename: Alison K
authors.initials: AK
authors.lastname: Klika
authors.forename: Wael K
authors.initials: WK
authors.lastname: Barsoum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation; D002648:Child; D015331:Cohort Studies; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000382:microbiology; D006622:Hip Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007719:Knee Joint / Q000382:microbiology; D007720:Knee Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D049451:Nomograms; D020959:Polyethylene; D057234:Preoperative Period; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D020959:Polyethylene