Is two-stage reimplantation effective for virulent pathogenic infection in a periprosthetic hip? A retrospective analysis.
OBJECTIVE
To investigate the effectiveness of two-stage reimplantation using antibiotic-loaded bone cement (ALBC) and the risk factors associated with failure to control periprosthetic joint infection (PJI).


METHODS
We retrospectively reviewed 38 consecutive hips managed using two-stage reimplantation with ALBC. The mean follow-up period was 5.4 years (range: 2.5-9 years).


RESULTS
The causative pathogens were isolated from 29 patients (76%), 26 of whom were infected with highly virulent organisms. Sixteen patients (42%) underwent at least two first-stage debridements. An increased debridement frequency correlated significantly with high comorbidity (P < 0.001), a lower preoperative Harris hip score (HHS; P < 0.001), antimicrobial resistance, and gram-negative and polymicrobial infection (P = 0.002). Of the 35 patients who underwent two-stage reimplantation, 34 showed no signs of recurrence of infection. The mean HHS improved from 46 ± 12.64 to 78 ± 10.55 points, with 7 (20%), 12 (34%), 11 (32%) and 5 (14%) patients receiving excellent, good, fair and poor ratings, respectively.


CONCLUSIONS
The current study demonstrated that two-stage reimplantation could successfully treat PJI after hip arthroplasty. However, the ability of ALBC to eradicate infection was limited because frequent debridement was required in high-risk patients (i.e., patients who are either in poor general health due to associated comorbidities or harbor infections due to highly virulent, difficult-to-treat organisms).


METHODS
Level IV.
Yong-Cheol Yoon, Orthopedic Trauma Division, Gachon University Gil Hospital, Incheon 405-760, South Korea.
Yong-Cheol
YC
Yoon
Yong-Cheol Yoon, Orthopedic Trauma Division, Gachon University Gil Hospital, Incheon 405-760, South Korea.
Devendra
D
Lakhotia
Yong-Cheol Yoon, Orthopedic Trauma Division, Gachon University Gil Hospital, Incheon 405-760, South Korea.
Jong-Keon
JK
Oh
Yong-Cheol Yoon, Orthopedic Trauma Division, Gachon University Gil Hospital, Incheon 405-760, South Korea.
Jun Gyu
JG
Moon
Yong-Cheol Yoon, Orthopedic Trauma Division, Gachon University Gil Hospital, Incheon 405-760, South Korea.
Kumar
K
Prashant
Yong-Cheol Yoon, Orthopedic Trauma Division, Gachon University Gil Hospital, Incheon 405-760, South Korea.
Won Yong
WY
Shon
Antibiotic-loaded bone cement; Debridement; Periprosthetic infection; Two-stage reimplantation