title: Risk factors and a prognostic model of hip periprosthetic infection recurrence after surgical treatment using articulating and non-articulating spacers.
abstract: The purpose of this study was evaluation of the efficacy of the first step of a two-stage procedure for treatment of hip prosthetic joint infection (PJI) using articulating and non-articulating spacers as well as development of a prediction model and prognostic score for infection recurrence.
  
  
  
  In a cohort of 217 patients treated for PJI of the hip, demographic characteristics, clinical symptoms, body temperature, body mass index (BMI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC), microbiological cultures and the type of the spacer used were retrospectively analyzed for association with the recurrence of PJI.
  
  
  
  Patients with infection recurrence had increased levels of ESR and CRP (P < 0.001) together with higher BMI and shorter infection manifestation period after previous surgery (P < 0.05). Among these patients, there was no significant difference of clinical characteristics between subjects with articulating and non-articulating spacers. Microbial associations were more often identified in patients with recurrent infection (50 %, P < 0.01) where Gram-negative bacteria were predominant (61.5 %, P < 0.01). These patients had higher percentage of Acinetobacter sp. and P. aeruginosa isolates (28.2 %, P < 0.01).
  
  
  
  Efficacy of the first step of two-stage revision was 64.1 %. Placement of either articulating or non-articulating spacers did not influence recovery from PJI. Laboratory values of ESR, CRP, BMI and the type of previous surgery were identified as main factors that affect outcomes of the two-stage procedure. A prognostic model with the calculation of a total risk score for PJI recurrence was developed.
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation.|Mechnikov North-Western State Medical University, St. Petersburg, Russian Federation.
authors.forename: Rashid
authors.initials: R
authors.lastname: Tikhilov
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation. clinpharm-rniito@yandex.ru.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Bozhkova
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation.
authors.forename: Alexey
authors.initials: A
authors.lastname: Denisov
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Labutin
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation.
authors.forename: Igor
authors.initials: I
authors.lastname: Shubnyakov
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation.
authors.forename: Vadim
authors.initials: V
authors.lastname: Razorenov
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation.
authors.forename: Vasilii
authors.initials: V
authors.lastname: Artyukh
authors.affiliation: Mechnikov North-Western State Medical University, St. Petersburg, Russian Federation.
authors.forename: Olga
authors.initials: O
authors.lastname: Klitsenko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006621:Hip Joint / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Orthopaedic spacers; Prediction model; Prosthetic joint infection; Total risk score; Two-stage revision