title: Transfer of patient care during two-stage exchange for periprosthetic joint infection leads to inferior outcomes.
abstract: The two-stage exchange algorithm is the gold standard for managing chronic periprosthetic joint infection (PJI); this study evaluated the impact of having the stages performed at different institutions. Patients with a chronically infected total joint arthroplasty (hip or knee) with initial resection at an outside hospital and subsequent care at our institution (transferred group) were identified then matched with a similar cohort that received both stages at our institution (continuous group). Eighteen patients (transferred group) were compared to 36 matched controls. There were significantly lower rates of successful reimplantation and retention, longer duration of treatment and more procedures in the transferred group compared to the continuous group. Patients transferred during their care for chronic PJI underwent more surgeries, longer treatment times, and less favorable outcomes.
authors.affiliation: Department of Orthopaedics, West Virginia University School of Medicine, Morgantown, West Virginia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Dietz
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center for Outpatient Care, Boston, Massachusetts.
authors.forename: Ho-Rim
authors.initials: HR
authors.lastname: Choi
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center for Outpatient Care, Boston, Massachusetts.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Freiberg
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center for Outpatient Care, Boston, Massachusetts.
authors.forename: Hany
authors.initials: H
authors.lastname: Bedair
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D016459:Prosthesis-Related Infections / Q000601:surgery* / Q000628:therapy; D012086:Reoperation / Q000379:methods*; D016896:Treatment Outcome
keywords: periprosthetic joint infection; transfer of patient; two-stage revision