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Difficult-To-Treat Periprosthetic Hip Infection: Outcomes of Debridment
- Authors: Liventsov V.N.1, Bozhkova S.A.1, Kochish A.Y.1, Artyukh V.A.1, Razorenov V.L.1, Labutin D.V.1
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Affiliations:
- Vreden Russian Research Institute of Traumatology and Orthopedics
- Issue: Vol 25, No 4 (2019)
- Pages: 88-97
- Section: Clinical studies
- URL: https://journal.rniito.org/jour/article/view/1348
- DOI: https://doi.org/10.21823/2311-2905-2019-25-4-88-97
- ID: 1348
Cite item
Abstract
Purpose of the study — to compare management efficiency for difficult-to-treat periprosthetic hip joint infection (PJI) during resection arthroplasty with grafting by vastus lateralis pedicle island flap in comparison with insertion of an antimicrobial-loaded cement spacer. Material and Methods. 132 patients were included into the retrospective study who underwent treatment from 2012 until 2018 including removal of orthopaedic implant, radical surgical debridement of infection focus, resection arthroplasty with grafting by vastus lateralis pedicle island muscle flap (PMF group — 57 patients) or insertion of antibacterial-loaded cement spacer (AMS group — 75 patients). The authors examined medical histories, nature of infection process, infection agent type, laboratory data in respect of systemic inflammation, size of bone defects, follow up status and remission of PJI in the late period. Results. 89.4% of patients (n = 51) who underwent grafting by vastus lateralis pedicle island flap had a history of 3 and more prior surgical procedures in the same area. At the same time the share of such patients in the spacer group was only 38.6% (n = 29) (p<0.0001) while the share of patients with two and more recurrences was 78.9% (n = 45) and 25.3% (n = 19), respectively (p<0.0001). No significant variances were observed between the groups in respect of type composition of PJI microbial infection agents. The infection in a vast majority of patients in both groups was caused by microbial association: 77.2% and 72.0% in PMF and AMS groups, respectively. In the early postoperative period secondary revision of surgical site was performed in 35% and 28% of cases in PMF group (n = 20) and AMS group (n = 21), respectively, including due to recurrent infection in 15.8% and 28% of cases, respectively. Stable remission of difficult-to-treat PJI in PMF group was 96.5% and 45.3% in AMS group. Conclusion. Despite some cases that required secondary revisions in early postoperative period the resection arthroplasty in combination with pedicle muscle flap can be considered a surgery of choice for management of recurrent difficultto-treat PJI with feasible re-implantation of prosthesis against the stable remission of infection.
About the authors
V. N. Liventsov
Vreden Russian Research Institute of Traumatology and Orthopedics
Author for correspondence.
Email: vnliventsov@yandex.ru
Vitaly N. Liventsov — Orthopedic Surgeon, Department of Purulent Surgery Russian Federation
S. A. Bozhkova
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Svetlana A. Bozhkova — Dr. Sci. (Med.), Head of the Research Department of Prevention and Treatment of Wound Infection and Department of Clinical Pharmacology Russian Federation
A. Yu. Kochish
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Aleksandr Yu. Kochish — Dr. Sci. (Med.), Professor, Deputy Director for Science and Education Russian Federation
V. A. Artyukh
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Vasilii A. Artyukh — Cand. Sci. (Med.), Head of Department of Purulent Surgery Russian Federation
V. L. Razorenov
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Vadim L. Razorenov — Cand. Sci. (Med.), Deputy Chief Medical Officer Russian Federation
D. V. Labutin
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Dmitry V. Labutin — Research Assistant at the Research Department of Prevention and Treatment of Wound Infection Russian Federation
References
- Zimmerli W., Moser C. Pathogenesis and treatment concepts of orthopaedic biofilm infections. FEMS Immunol Med Microbiol. 2012;65(2):158-168. doi: 10.1111/j.1574-695X.2012.00938.x.
- Papadopoulos A., Ribera A., Mavrogenis A.F., RodriguezPardo D., Bonnet E., Salles M.J. et al. Multidrug and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration. Int J Antimicrob Agents. 2019;53(3): 294-301. doi: 10.1016/j.ijantimicag.2018.10.018.
- Rosteius T., Jansen O., Fehmer T., Baecker H., Citak M., Schildhauer T.A., Geßmann J. Evaluating the microbial pattern of periprosthetic joint infections of the hip and knee. J Med Microbiol. 2018;67(11):1608-1613. doi: 10.1099/jmm.0.000835.
- Fagotti L., Tatka J., Salles M.J.C., Queiroz M.C. Risk Factors and Treatment Options for Failure of a TwoStage Exchange. Curr Rev Musculoskelet Med. 2018;11(3): 420-427. doi: 10.1007/s12178-018-9504-1.
- Винклер Т., Трампуш А., Ренц Н., Перка К., Божкова С.А. Классификация и алгоритм диагностики и лечения перипротезной инфекции тазобедренного сустава. Травматология и ортопедия России. 2016;(1): 33-45. doi: 10.21823/2311-2905-2016-0-1-33-45.
- Rodríguez-Pardo D., Pigrau C., Lora-Tamayo J., Soriano A., del Toro M.D. Cobo J., et al. Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study. Clin Microbiol Infect. 2014;20:O911-O919. doi: 10.1111/1469-0691.12649.
- Bozhkova S., Tikhilov R., Labutin D., Denisov A., Shubnyakov I., Razorenov V. et al. Failure of the first step of two-stage revision due to polymicrobial prosthetic joint infection of the hip. J Orthop. Traumatol. 2016;17(4):369-376. doi: 10.1007/s10195-016-0417-8.
- Zmistowski B., Fedorka C.J., Sheehan E. Sheehan E., Deirmengian G., Austin M.S., Parvizi J. Prosthetic joint infection caused by gram-negative organisms. J Arthroplasty. 2011;26(Suppl 6):104-108. doi: 10.1016/j.arth.2011.03.044.
- Hsieh P.H., Lee M.S., Hsu K.Y., Chang Y.H., Shih H.N., Ueng S.W. Gram-negative prosthetic joint infections: risk factors and outcome of treatment. Clin Infect Dis. 2009;49(7):1036-1043. doi: 10.1086/605593.
- Suda A.J., Heppert V. Vastus lateralis muscle flap for infected hips after resection arthroplasty From BG Trauma Centre, Ludwigshafen, German. 2010. J Bone Joint Surg Br. 2010;92(12):1654-1658. doi: 10.1302/0301-620X.92B12.25212.
- Shieh S.J., Jou I.M. Management of intractable hip infection after resectional arthroplasty using a vastus lateralis muscle flap and secondary total hip arthroplasty. Plast Reconstr Surg. 2007;120(1):202-207. doi: 10.1097/01.prs.0000264067.68714.a6.
- Тихилов Р.М., Кочиш А.Ю., Разоренов В.Л. Использование островковых лоскутов из латеральной широкой мышцы бедра в лечении пациентов с гнойными осложнениями после эндопротезирования тазобедренного сустава. Травматология и ортопедия России. 2008;(4):7-14.
- Choa R., Gundle R., Critchley P., Giele H. Successful management of recalcitrant infection related to total hip replacement. J Bone Joint Surg Br. 2011;93(6):751-754. doi: 10.1302/0301-620X.93B6.25726.
- Huang K.C., Peng K.T., Li Y.Y., Tsai Y.H., Huang T.J., Wei Hsu R.W. Modified vastus lateralis flap in treating a difficult hip infection. J Trauma. 2005;59(3):665-671.
- Akgün D., Perka C., Trampuz A., Renz N. Outcome of hip and knee periprosthetic joint infections caused by pathogens resistant to biofilm-active antibiotics: results from a prospective cohort study. Arch Orthop Trauma Surg. 2018;138(5):635-642. doi: 10.1007/s00402-018-2886-0.
- Nelson C.L., Jones R.B., Wingert N.C., Foltzer M., Bowen T.R. Sonication of antibiotic spacers predicts failure during two-stage revision for prosthetic knee and hip infections. Clin Orthop Relat Res. 2014;472(7):2208- 2214. doi: 10.1007/s11999-014-3571-4.
- Божкова С.А., Касимова А.Р., Тихилов Р.М., Полякова Е.М., Рукина А.Н., Шабанова В.В., Ливенцов В.Н. Неблагоприятные тенденции в этиологии ортопедической инфекции: результаты 6-летнего мониторинга структуры и резистентности ведущих возбудителей. Травматология и ортопедия России. 2018;24(4):20-31.
- Агеевец В.А., Лазарева И.В., Сидоренко С.В. Проблема устойчивости к карбапенемным антибиотикам: распространение карбапенемаз в мире и России, эпидемиология, диагностика, возможности лечения. Фарматека. 2015;14(307):9-16.
- Шайдуллина Э.Р., Эйдельштейн М.В., Склеенова Е.Ю., Сухорукова М.В., Козлов Р.С. Антибиотикорезистентность нозокомиальных карбапенемазопродуцирующих штаммов Enterobacterales в России: результаты эпидемиологического исследования 2014-2016 гг. Клиническая микробиология и антимикробная химиотерапия. 2018;20(4):362-369. doi: 10.36488/cmac.2018.4.362-369.
- Тапальский Д.В. Чувствительность к комбинациям антибиотиков продуцирующих карбапенемазы нозокомиальных штаммов грамотрицательных бактерий, выделенных в Беларуси. Клиническая микробиология и антимикробная химиотерапия. 2018; 20(3):182-191.
- Zimmerli W., Trampuz A., Ochsner P.E. Prostheticjoint infections. N Engl J Med. 2004;351(16):1645-1654. doi: 10.1056/NEJMra040181.
- Кудайкулов М.К., Ботобеков С.С., Саякбаев М.Б., Абдурасулов М.К., Мавлянов О.М., Насыров У.И. Мышечная, кожно-мышечная пластика остеомиелитических костных полостей. Травматология и ортопедия России. 2006;2(40):171-172.
- Лисицкий И.Ю., Боев М.В., Евсюков А.А. Пластика мышечными лоскутами на питающей ножке в практике лечения инфекционных осложнений стабилизирующих операций на позвоночнике. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2010;1:22-24.
- Линник С.А., Фомин Н.Ф., Динаев Ш.Л., Хаймин В.В., Линник А.А. Способ пластики костных дефектов у больных с остеомиелитом предплечья мышечным лоскутом, сфомированным из musculus pronator qvadratus. Травматология и ортопедия России. 2011;(3):97-100.
- Самарцев В.А., Кадынцев И.В. Пути профилактики и способы хирургического лечения посттравматического остеомиелита костей конечностей. Пермский медицинский журнал. 2015;32(5):18-23.
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