Aaron R. Owen MD, Oliver B. Dilger BA, Nicholas A. Bedard MD, Charles P. Hannon MD, MBA, Tad M. Mabry MD, Daniel J. Berry MD, Matthew P. Abdel MD
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引用次数: 0
Abstract
Background
A two-stage exchange arthroplasty is the standard management method of chronic periprosthetic joint infections (PJIs) of the hip in North America. However, a subset of patients become reinfected and may require a repeat two-stage exchange arthroplasty. The purpose of the present study was to assess revisions, reoperations, and risk factors for failure associated with repeat two-stage exchange arthroplasties for recurrent PJIs after total hip arthroplasty (THA).
Methods
We identified 52 repeat two-stage exchange THAs completed from 2000 to 2021 at a single, high-volume academic medical center. The mean age was 61 years, 39% were women, and the mean body mass index was 33. At the time of the repeat two-stage exchange, high-dose antibiotic spacers were used in 90% of patients (28 articulating, 19 nonarticulating), and 10% had a resection arthroplasty in the interim between stages. The mean time from repeat first stage to reimplantation was 33 weeks. At the final follow-up, 54% of patients were on chronic antibiotic therapy. The mean follow-up was 6 years.
Results
The 7-year survivorships free of re-revision for reinfection, any re-revision, and any reoperation were 85, 57, and 50%, respectively. The leading indications for re-revision were dislocation (45%) and PJI (35%). McPherson host grade C was a significant risk factor for re-revision for infection (HR [hazard ratio] 5, P = 0.04). Additionally, increased operative time at reimplantation was a risk for any reoperation (HR 1.06, P < 0.01) and reoperation for infection (HR 1.07, P < 0.01). At the final follow-up, 98% of patients had a revision THA in situ (one hip disarticulation).
Conclusions
Repeat two-stage exchange arthroplasty of the hip had a 7-year survivorship free of re-revision for infection that was 85%, but only 57% were free of any re-revision (most due to revision for dislocation). McPherson C hosts had a 5-fold increased risk of reinfection.
期刊介绍：
The Journal of Arthroplasty brings together the clinical and scientific foundations for joint replacement. This peer-reviewed journal publishes original research and manuscripts of the highest quality from all areas relating to joint replacement or the treatment of its complications, including those dealing with clinical series and experience, prosthetic design, biomechanics, biomaterials, metallurgy, biologic response to arthroplasty materials in vivo and in vitro.
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