Treatment Failure Among Infected Periprosthetic Total Hip Arthroplasty Patients
Ran Schwarzkopf*, 1, Bassem Mikhael 2, Elizabeth Wright 3, Daniel M Estok, II2, Jeffrey N Katz 3
1 Department of Orthopaedics Surgery, University of California Irvine, 101 The City Drive South, Orange, CA 92868, USA
2 Orthopaedic Department, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
3 Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Two-stage revision has been shown to be the most successful treatment in eradicating deep infection following total hiparthroplasty. We identified 62 patients treated by a two-stage revision. We defined “successful revision” as negative intraoperative cultures and no further infection-related procedure. We defined “eradication of infection” on the basis of negative cultures and clinical diagnosis at least one year after 2nd stage procedure. After a mean follow up of 2.7 years, eradication of the infection was documented in 91.1%, and a successful two-stage revision in 85.7% of patients. We observed no association between higher pre-reimplantation levels of ESR and C-reactive protein and lower likelihood of successful two-stage revision. We found an association between a history of another previous infected prosthetic joint and a failed 2nd stage procedure. Failure to achieve eradication of infection and successful two-stage revision occurs infrequently. Patients with prior history of a previous prosthetic joint infection are at higher risk of failure.
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