title: Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome.
abstract: OBJECTIVE
  Our purpose was to identify the success rate and factors predicting outcome of irrigation and debridement (I&D) in patients with deep periprosthetic joint infection (PJI) of the hip.
  
  
  METHODS
  We retrospectively reviewed clinical characteristics of patients with deep PJI after primary/revision total hip arthroplasty (THA) between January 2000 and May 2013 treated with I&D. Implant retention was the outcome of interest. Sixty patients (29 men and 31 women; mean age 64.9 years) were identified. Mean follow-up was 59 months (range, 12-168).
  
  
  RESULTS
  The implants were retained in 42 patients (70%). Failure of I&D treatment correlated with duration of symptoms >five days (p <0.001) and obesity [body mass index (BMI) ≥ 30)] (p = 0.0289). Treatment outcome was affected by the type of pathogen (p = 0.0482), with patients with methicillin-resistant staphylococci having significantly lower odds of success.
  
  
  CONCLUSIONS
  I&D can be a feasible option in THA patients presenting with acute deep PJI. Duration of symptoms >five days, isolation of methicillin-resistant staphylococci and obesity should be taken into consideration in pre-operative decision making.
authors.affiliation: Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th street, New York, NY, 10021, USA, yotriad@hotmail.com.
authors.forename: Georgios K
authors.initials: GK
authors.lastname: Triantafyllopoulos
authors.forename: Lazaros A
authors.initials: LA
authors.lastname: Poultsides
authors.forename: Vasileios I
authors.initials: VI
authors.lastname: Sakellariou
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: Peter K
authors.initials: PK
authors.lastname: Sculco
authors.forename: Yan
authors.initials: Y
authors.lastname: Ma
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Sculco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D015897:Comorbidity; D003646:Debridement; D005260:Female; D006621:Hip Joint / Q000382:microbiology; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
references.citation: Int Orthop. 2014 Jul;38(7):1363-8
references.pmid: 24638215
references.citation: Int Orthop. 2012 Apr;36(4):723-9
references.pmid: 21792609
references.citation: J Bone Joint Surg Am. 2014 Apr 16;96(8):624-30
references.pmid: 24740658
references.citation: Int Orthop. 2015 Jan;39(1):105-10
references.pmid: 25280863
references.citation: Acta Orthop. 2013 Dec;84(6):509-16
references.pmid: 24171687
references.citation: J Arthroplasty. 2010 Oct;25(7):1022-7
references.pmid: 20378306
references.citation: J Bone Joint Surg Am. 2005 Aug;87(8):1746-51
references.pmid: 16085614
references.citation: Clin Orthop Relat Res. 2013 Jan;471(1):250-7
references.pmid: 22552768
references.citation: J Antimicrob Chemother. 2009 Jun;63(6):1264-71
references.pmid: 19336454
references.citation: Orthop Traumatol Surg Res. 2011 Apr;97(2):134-8
references.pmid: 21388905
references.citation: J Bone Joint Surg Am. 2010 Sep 1;92(11):e13
references.pmid: 20810849
references.citation: Clin Orthop Relat Res. 2002 Oct;(403):23-8
references.pmid: 12360003
references.citation: Clin Orthop Relat Res. 2011 Nov;469(11):2992-4
references.pmid: 21938532
references.citation: J Arthroplasty. 2014 Mar;29(3):469-72
references.pmid: 23998990
references.citation: J Arthroplasty. 2012 Jun;27(6):857-64.e1-4
references.pmid: 22402229
references.citation: J Bone Joint Surg Am. 1998 Sep;80(9):1306-13
references.pmid: 9759815
references.citation: Bone Joint J. 2013 Nov;95-B(11):1450-2
references.pmid: 24151261
references.citation: J Arthroplasty. 2005 Oct;20(7 Suppl 3):46-50
references.pmid: 16214002
references.citation: Clin Orthop Relat Res. 2011 Nov;469(11):3043-8
references.pmid: 21553171
references.citation: Acta Orthop. 2013 Aug;84(4):380-6
references.pmid: 23848215
references.citation: Acta Orthop. 2011 Oct;82(5):530-7
references.pmid: 21992085
references.citation: Acta Orthop. 2012 Jun;83(3):227-32
references.pmid: 22489892
references.citation: J Bone Joint Surg Am. 1996 Apr;78(4):512-23
references.pmid: 8609130
references.citation: Clin Orthop Relat Res. 2015 Feb;473(2):453-9
references.pmid: 25024028
references.citation: Am J Med. 2006 Nov;119(11):993.e7-10
references.pmid: 17071171
references.citation: Clin Orthop Relat Res. 2012 Nov;470(11):3164-70
references.pmid: 22826016
references.citation: N Engl J Med. 2009 Aug 20;361(8):787-94
references.pmid: 19692690
references.citation: Instr Course Lect. 2003;52:223-45
references.pmid: 12690851
references.citation: Int Orthop. 2015 Mar;39(3):397-401
references.pmid: 25183296