Implant retention after acute and hematogenous periprosthetic hip and knee infections: Whom, when and how?
Periprosthetic joint infections (PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of care in North America for treating chronic infections, irrigation and debridement (I and D) with retention of implants has been used in an attempt to treat the other two types of PJIs. The rationale of this approach is that a PJI may be eradicated without the need of explanting the prostheses, as long as it has not transitioned into a chronic state. With the present paper, we review current evidence regarding the role of I and D with implant retention for treating PJIs of the hip and the knee. While a very wide range of success rates is reported in different studies, a short period of time between initiation of symptoms and intervention seems to play a prominent role with regards to a successful outcome. Moreover, pathogens of higher virulence and resistance to antibiotics are associated with a poorer result. Specific comorbidities have been also correlated with a less favorable outcome. Finally, one should proceed with serial I and Ds only under the condition that a predefined, aggressive protocol is applied. In conclusion, when treating a PJI of the hip or the knee, all the above factors should be considered in order to decide whether the patient is likely to benefit from this approach.
Georgios K Triantafyllopoulos, Vasileios Soranoglou, Lazaros A Poultsides, Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, United States.
Georgios K
GK
Triantafyllopoulos
Georgios K Triantafyllopoulos, Vasileios Soranoglou, Lazaros A Poultsides, Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, United States.
Vasileios
V
Soranoglou
Georgios K Triantafyllopoulos, Vasileios Soranoglou, Lazaros A Poultsides, Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, United States.
Stavros G
SG
Memtsoudis
Georgios K Triantafyllopoulos, Vasileios Soranoglou, Lazaros A Poultsides, Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, United States.
Lazaros A
LA
Poultsides
Implant retention; Irrigation and debridement; Periprosthetic infection; Total hip arthroplasty; Total knee arthroplasty
J Arthroplasty. 2014 Feb;29(2 Suppl):100-3
24360491
Int Orthop. 2010 Apr;34(4):505-10
19458950
J Arthroplasty. 2014 May;29(5):877-82
24199997
J Arthroplasty. 2009 Sep;24(6 Suppl):101-4
19553077
Clin Orthop Relat Res. 2010 Aug;468(8):2029-38
20224958
Int Orthop. 2012 Apr;36(4):723-9
21792609
Int Orthop. 2013 Aug;37(8):1471-5
23695880
J Bone Joint Surg Am. 2014 Apr 16;96(8):624-30
24740658
Clin Orthop Relat Res. 2012 Oct;470(10):2708-16
22552769
Eur J Nucl Med Mol Imaging. 2012 May;39(5):892-909
22361912
Clin Orthop Relat Res. 2011 Apr;469(4):970-6
20544317
J Infect. 2007 Jul;55(1):1-7
17343916
Antimicrob Agents Chemother. 2009 Nov;53(11):4772-7
19687237
Clin Infect Dis. 1997 May;24(5):914-9
9142792
Acta Orthop. 2013 Dec;84(6):509-16
24171687
J Bone Joint Surg Am. 1999 Oct;81(10):1434-45
10535593
Clin Infect Dis. 2003 Apr 1;36(7):845-9
12652384
J Arthroplasty. 2010 Oct;25(7):1022-7
20378306
Clin Microbiol Infect. 2007 Jun;13(6):586-91
17331125
Clin Orthop Relat Res. 2013 Jan;471(1):250-7
22552768
Orthop Traumatol Surg Res. 2012 Apr;98 (2):144-50
22364829
J Arthroplasty. 2016 Jan;31(1):219-24
26216228
Clin Orthop Relat Res. 2007 Aug;461:130-5
17438469
J Antimicrob Chemother. 2009 Jun;63(6):1264-71
19336454
Orthop Traumatol Surg Res. 2011 Apr;97(2):134-8
21388905
Orthop Clin North Am. 1991 Jul;22(3):531-8
1852429
J Arthroplasty. 2015 Apr;30(4):649-57
25466169
J Bone Joint Surg Am. 2003;85-A Suppl 1:S75-80
12540674
Clin Orthop Relat Res. 2002 Oct;(403):23-8
12360003
Instr Course Lect. 1999;48:111-22
10098033
Clin Orthop Relat Res. 2011 Nov;469(11):2992-4
21938532
J Arthroplasty. 2014 Mar;29(3):469-72
23998990
Clin Infect Dis. 2006 Feb 15;42(4):471-8
16421790
J Arthroplasty. 2012 Jun;27(6):857-64.e1-4
22402229
J Bone Joint Surg Am. 1998 Sep;80(9):1306-13
9759815
J Bone Joint Surg Am. 2016 Jun 15;98 (12 ):992-1000
27307359
Bone Joint J. 2013 Nov;95-B(11):1450-2
24151261
Scand J Infect Dis. 2009;41(11-12):831-40
19922065
Infection. 2003 Mar;31(2):99-108
12682815
Antimicrob Agents Chemother. 2013 Jan;57(1):350-5
23114758
Clin Orthop Relat Res. 2011 Nov;469(11):3043-8
21553171
Acta Orthop. 2013 Aug;84(4):380-6
23848215
Eur J Nucl Med Mol Imaging. 2008 Nov;35(11):2122-32
18704405
Clin Orthop Relat Res. 2010 Aug;468(8):2024-8
20224960
Clin Orthop Relat Res. 1991 Dec;(273):105-12
1959256
J Bone Joint Surg Br. 2006 Jul;88(7):943-8
16799001
Acta Orthop. 2011 Oct;82(5):530-7
21992085
Clin Orthop Relat Res. 2001 Nov;(392):15-23
11716377
Clin Infect Dis. 1999 Aug;29(2):292-5
10476729
Proc Natl Acad Sci U S A. 2009 Apr 7;106(14):5883-8
19293374
Acta Orthop. 2012 Jun;83(3):227-32
22489892
J Bone Joint Surg Am. 1996 Apr;78(4):512-23
8609130
Int Orthop. 2015 Jun;39(6):1203-9
25820839
Int Orthop. 2011 Aug;35(8):1157-64
20959981
J Arthroplasty. 1990 Mar;5(1):35-9
2319246
Acta Orthop. 2007 Dec;78(6):755-65
18236181
Am J Med. 2006 Nov;119(11):993.e7-10
17071171
Clin Orthop Relat Res. 2012 Nov;470(11):3164-70
22826016
N Engl J Med. 2009 Aug 20;361(8):787-94
19692690
Instr Course Lect. 2003;52:223-45
12690851
J Arthroplasty. 1997 Jun;12 (4):426-33
9195319
Clin Microbiol Infect. 2011 Mar;17(3):439-44
20412187
J Arthroplasty. 2013 Mar;28(3):395-400
23151368