An often-unrecognized entity as cause of recurrent infection after successfully treated two-stage exchange arthroplasty: hematogenous infection

An often-unrecognized entity as cause of recurrent infection after successfully treated two-stage... Introduction Reinfection after two-stage exchange arthroplasty is a difficult clinical scenario with limited data on adequate treatment algorithms. Beside the possibility of treatment failure and a new intraoperative infection at the time of reimplanta- tion, hematogenous seeding could play an up to date underestimated crucial role as another cause of an infection after two- stage exchange. The aim of this study was to evaluate its incidence and treatment possibilities in a prospectively followed case series. Methods All consecutive hip and knee periprosthetic joint infection cases (93 hips and 89 knees) treated according to a standardized diagnostic and therapeutic algorithm at our institution with a two-stage exchange arthroplasty from 2013 to 2015 were included and followed prospectively to identify recurrent infections due to hematogenous seeding. Results Six percent from our septic revision hip and knee arthroplasties (11 of 182, including 5 hips and 6 knees) were identified with a hematogenous reinfection after a mean follow-up of 31.8 months (range 14–48 months). The mean time to reinfection after reimplantation was 12.2 months (range 3.1–35.1). In all but two cases was the causative microorganism dif- ferent than isolated at the time of initial two-stage exchange. In 5 of 11 patients, the primary focus of http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Orthopaedic and Trauma Surgery Springer Journals

An often-unrecognized entity as cause of recurrent infection after successfully treated two-stage exchange arthroplasty: hematogenous infection

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Publisher
Springer Berlin Heidelberg
Copyright
Copyright © 2018 by Springer-Verlag GmbH Germany, part of Springer Nature
Subject
Medicine & Public Health; Orthopedics
ISSN
0936-8051
eISSN
1434-3916
D.O.I.
10.1007/s00402-018-2972-3
Publisher site
See Article on Publisher Site

Abstract

Introduction Reinfection after two-stage exchange arthroplasty is a difficult clinical scenario with limited data on adequate treatment algorithms. Beside the possibility of treatment failure and a new intraoperative infection at the time of reimplanta- tion, hematogenous seeding could play an up to date underestimated crucial role as another cause of an infection after two- stage exchange. The aim of this study was to evaluate its incidence and treatment possibilities in a prospectively followed case series. Methods All consecutive hip and knee periprosthetic joint infection cases (93 hips and 89 knees) treated according to a standardized diagnostic and therapeutic algorithm at our institution with a two-stage exchange arthroplasty from 2013 to 2015 were included and followed prospectively to identify recurrent infections due to hematogenous seeding. Results Six percent from our septic revision hip and knee arthroplasties (11 of 182, including 5 hips and 6 knees) were identified with a hematogenous reinfection after a mean follow-up of 31.8 months (range 14–48 months). The mean time to reinfection after reimplantation was 12.2 months (range 3.1–35.1). In all but two cases was the causative microorganism dif- ferent than isolated at the time of initial two-stage exchange. In 5 of 11 patients, the primary focus of

Journal

Archives of Orthopaedic and Trauma SurgerySpringer Journals

Published: Jun 5, 2018

References

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