The First-Stage Treatment Аlgorithm for Deep Infected Total Hip Arthroplasty

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Abstract

Background. Periprosthetic infection after total hip arthroplasty is a relatively common and severe complication. A two-stage revision with the temporary use of a spacer is the gold standard treatment for the deep infected total hip arthroplasty. Some authors report mechanical complications associated with spacers, which can lead to a poor functional outcome. Therefore, the aim of the study was to analyze the effectiveness of the first-stage of treatment of hip PJI with a two-stage method and to develop an spacer application algorithm in order to achieve the optimal functional result.

Material and Methods. Between 2015 and 2017, 38 patients with deep periprosthetic infection received an articulation spacer as part of a two-stage protocol in Botkin Moscow City Hospital. The mean age was 60.5 (interquartile range from 5 2 to 69) years. Five different types of spacers were us ed in the study, selected individually according to theW. Paprosky acetabular defects classification. The overall frequency of complications was evaluated.

Results. The overall periprosthetic infection treatment effectiveness was 92.1%. There was the recurrent infection in 3 patients (7.9%), in 2 (5.26%) cases microbial associations were founded. Mechanical complications occurred in 8 (21%) patients. Spacer dislocation occurred in 4 (10.4%) cases, spacer fracture in another 2 (5.2%). There were also 2 cases of protrusion into the pelvis (5.2%).

Conclusions. The first stage a two-stage revision hip arthroplasty should be carefully plarmed. To choose the appropriate spacer we proposed an algorithm based on our data to achieve a better functional result.

About the authors

V. Yu. Murylev

Sechenov First Moscow State Medical University;
Botkin Moscow City Hospital

Author for correspondence.
Email: nmuril@yandex.ru
Valery Yu. Murylev — Dr. Sci (Med), professor of Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University; head of Moscow City arthroplasty Centre, Botkin Moscow City Hospital Russian Federation

G. A. Kukovenko

Sechenov First Moscow State Medical University;
Botkin Moscow City Hospital

Email: fake@neicon.ru
Grigorii A. Kukovenko — РhD student, Sechenov First Moscow State Medical University; orthopaedic surgeon, Botkin Moscow City Hospital Russian Federation

P. M. Elizarov

Sechenov First Moscow State Medical University;
Botkin Moscow City Hospital

Email: fake@neicon.ru
Павел Михайлович Елизаров — канд. мед. наук, доцент кафедры травматологии, ортопедии и хирургии катастроф, ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова»Минздрава России; врач, ГБУЗ «Городская клиническая больница им. С.П. Боткина» Департамента здравоохранения г. Москвы Russian Federation

L. R. Ivanenko

Sechenov First Moscow State Medical University

Email: fake@neicon.ru

Leonid R. Ivanenko — PhD student

Moscow

Russian Federation

G. L. Sorokina

Botkin Moscow City Hospital

Email: fake@neicon.ru

Galina L. Sorokina — orthopaedic surgeon

Moscow,

Russian Federation

Ya. A. Rukin

Sechenov First Moscow State Medical University

Email: fake@neicon.ru

Yaroslav A. Rukin — Cand. Sci. (Med), assistant professor. Department of Traumatology, Orthopaedics and Disaster Surgery hopaedic surgeon

Moscow,

Russian Federation

S. S. Alekseev

Sechenov First Moscow State Medical University

Email: fake@neicon.ru

Semen S. Alekseev — PhD student

Moscow,

Russian Federation

V. G. Germanov

Sechenov First Moscow State Medical University

Email: fake@neicon.ru

Valery G. Germanov — Cand. Sci. (Med), assistant professor. Department of Traumatology, Orthopaedics and Disaster Surgery

Moscow,

Russian Federation

References

  1. Вejon Р., Вerendt А., Atkins В., Green N., Parry Н., Masters S. et al. Two-stage revision for prosthetic joint infection: predictors of outcome and the role of reimplantation microbiology. / Ant/m/crob Chemother. 2010;65(3):569- 575. doi: 10.1093/jac/dkp469.
  2. Bouzakis K., Michailidis N., Mesomeris G. et al. Investigation of mechanical properties of antibiotics- loaded acrylic bone cement. Proceedings of the 3rd International Conference on Manufacturing Engineering (ICMEN), 1-3 October 2008, Chalkidiki, Greece. Available from: https://www.researchgate.net/publication/237669337.
  3. Choi H., Beecher B., Bedair H. Mortality after septic versus aseptic revision total hip arthroplasty: a matched- cohort study. ] Arthroplasty. 2013;28(8 Suppl.):56-58. doi: 10.1016/j.arth.2013.02.041.
  4. Faschingbauer M., Reichel H., Bieger R., Карре T. Mechanical compUcations with one hundred and thirty eight (antibiotic-laden) cementspacers in the treatment of periprosthetic infection after total hip arthroplasty. Int Orthop. 2015;39(5):989-994. doi: 10.1007/S00264-014-2636-Z.
  5. Parvizi J., Gehrke T., Chen A.F. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J. 2013;95-B(11):1450-1452. doi: 10.1302/0301-620X.95B11.33135.
  6. Gomez M., Tan T., Manrique J., Deirmengian G., Parvizi J. The fate of spacers in the treatment of periprosthetic joint infection. / Bone Joint Surg Am. 2015;97(18):1495-1502. doi: 10.2106/JBIS.N.00958.
  7. Greidanus N.V., Masri B.A., Garbuz D.S., Wilson S.D., McAlinden M.G., Xu M., Duncan C.P. Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty. A prospective evaluation. J Bone Joint Surg Am. 2007;89:1409-1416. doi: 10.2106/JBIS.D.02602.
  8. Jung J., Schmid N., Kelm J., Schmitt E., Anagnostakos K. Complications after spacer implantation in the treatment of hip joint infections. Int J Med Sci. 2009;6(5):265-273. doi: 10.7150/ijms.6.265.
  9. Kurtz S.M., Lau E., Watson H., Schmier J.K., Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012;27(8 Suppl):61-65.el. doi: 10.1016/j.arth.2012.02.022.
  10. Lim S., Park J., Moon Y., Park Y. Treatment of periprosthetic hip infection caused by resistant microorganisms using 2-stage reimplantation protocol. J Arthroplasty. 2009;24(8):1264-1269. doi: 10.1016/j.arth.2009.05.012.
  11. Meehan J., Jamali A.A., Nguyen H. Prophylactic antibiotics in hip and knee arthroplasty. J Bone Joint Surg Am. 2009;91(10):2480-2490. doi: 10.2106/JBJS.H.01219.
  12. Parvizi J., Adeli В., Zmistowski В., Restrepo С., Greenwald A.S. Management of Periprosthetic Joint Infection: The Current Knowledge. J Bone Joint Surg Am. 2012;94(14):el04. doi: 10.2106/JBJS.K.01417.
  13. Toms A., Davidson D., Masri B., Duncan C. The management of peri-prosthetic infection in total joint arthroplasty. J Bone Joint Surg Br. 2006;88(2):149-155. doi: 10.1302/0301-620X.88B2.17058.
  14. Uchiyama K., Takahira N., Fukushima K., Moriya M., Yamamoto T., Minegishi Y. at al. Two-stage revision total hip arthroplasty for periprosthetic infections using antibiotic-impregnated cement spacers of various types and materials. ScientificWorld Journal. 2013 Dec 7; 2013:147248. doi: 10.1155/2013/147248.
  15. Van Thiel G.S., Berend K.R., Klein G.R., Gordon A.C., Lombardi A.V., Della Valle C.J. Intraoperative molds to create an articulating spacer for the infected knee arthroplasty. Clin Orthop Relat Res. 2011;469(4):994- 1001. doi: 10.1007/S11999-010-1644-6.
  16. Божкова C.A., Тихилов P.M., Краснова M.B., Рукина А.Н., Тишина В.В., Полякова Е.М., Торопов С.С. Профиль резистентности возбудителей как основа выбора эффективного антибиотика при стафилококковых инфекциях протезированных суставов. Клиническая микробиология и антимикробная химиотерапия 2013;15(2):115-123.
  17. Винклер T., Трампуш A., Ренц H., Перка К., Божкова С.A. Классификация и алгоритм диагностики и лечения перипротезной инфекции тазобедреішого сустава. Травматология и ортопедия России. 2016;(1):33-45. doi: 10.21823/2311-2905-2016-0-1-33-45.
  18. Кавалерский Г.М., Мурылев В.Ю., Рукин Я.А., Елизаров П.М., Музыченков А.В. Ревизионная хирургия тазобедренного сустава: роль индивидуальных артикулирующих спейсеров. Кафедра травматологии и ортопедии. 2014;(4):4-8.
  19. Лю Б., Тихилов P.M., Шубняков И.И., Разоренов B. Л., Денисов А.О., Божкова С.А., Артюх В.А., Клиценко О.А., Тотоев З.А. Эффективность первого этапа двухэтапной ревизии при параэндо- протезной инфекции тазобедренного сустава. Травматология и ортопедия России. 2014;(3):5-14. doi: 10.21823/2311-2905-2014-0-3-5-14.
  20. Материалы Международной согласительной конференции по перипротезной инфекции [Proceeding of the International Consensus Conference on periprosthetic infection]. Пер. c англ. СПб.: РНИИТО им. P.P. Вредена, 2014.355 с.
  21. Мурылев В.Ю., Куковенко Г.А., Елизаров П.М., Рукин Я.А., Цыгин Н.А. Перипротезная инфекция при эндопротезировании тазобедренного сустава. Врач. 2018;29(3):17-22. doi: 10.29296/25877305-2018-03-04.

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