Improvement of Perioperative Management of Patients Undergoing Surgical Treatment for Hip Periprosthetic Joint Infection

Cover Page


Cite item

Full Text

Abstract

Two-stage revision arthroplasty in chronic hip periprosthetic joint infection cases is the “gold standard” treatment. First stage debridement leads to large intraoperative and drainage blood loss using standard protocols for thromboprophylaxis and drainage of the surgical wound, which is a significant disadvantage of perioperative management of such patients.

The aim of the study was to determine the effect of modified management protocol with delayed start of thromboprophylaxis and a short period of drainage on the blood loss and the effectiveness of debridement with antibiotic-impregnated spacer placement in patients with hip periprosthetic joint infection.

Materials and Methods. A single-center prospective study was conducted. 90 patients underwent endoprosthesis components removal and antibiotic-impregnated spacer placement. Patients were divided into 3 groups: start of thromboprophylaxis before surgery and 3–4 days of drainage; start of thromboprophylaxis no earlier than 12 hours after surgery and 3–4 days of drainage; start of thromboprophylaxis no earlier than 12 hours after surgery and 1 day of drainage.

Results. There was a statistically significant (p<0.05) decrease of drainage and total blood loss, and transfused blood volume in cases with the delayed start of thromboprophylaxis and a short period of drainage. The proposed protocol was safe for prevention of venous thromboembolic complications and did not affect the frequency of periprosthetic hip joint infection recurrence. The effectiveness of the first stage of treatment — 89%, the second stage — 99% in 1 year after rehabilitation according to the second international consensus on musculoskeletal infection criteria.

Conclusion. The modified protocol of perioperative management is an effective and safe as a blood-saving strategy and can be proposed for widespread use.

About the authors

A. A. Kochish

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: kochishman@gmail.com
ORCID iD: 0000-0001-8573-1096

Andrei A. Kochish — Orthopaedic Surgeon

St. Petersburg

Russian Federation

S. A. Bozhkova

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: clinpharm-rniito@yandex.ru
ORCID iD: 0000-0002-2083-2424

Svetlana A. Bozhkova — Dr. Sci. (Med.), Head of the research department of wound infection prevention and treatment

St. Petersburg

Russian Federation

V. A. Artyukh

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: artyukhva@mail.ru
ORCID iD: 0000-0002-5087-6081

Vasilii A. Artyukh — Cand. Sci. (Med.), Head of septic surgery department

St. Petersburg

Russian Federation

V. N. Liventsov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: vnliventsov@yandex.ru
ORCID iD: 0000-0001-8748-2134

Vitaly N. Liventsov — Deputy Head of clinic for medical part

St. Petersburg

Russian Federation

A. V. Afanas’ev

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: avafanasev@rniito.ru
ORCID iD: 0000-0002-3097-7846

Alexander V. Afanas’ev — Orthopaedic Surgeon

St. Petersburg

Russian Federation

S. S. Toropov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: doctoropovss@yandex.ru
ORCID iD: 0000-0002-9451-1834

Sergei S. Toropov — Orthopaedic Surgeon

St. Petersburg

Russian Federation

References

  1. Kini S.G., Gabr A., Das R., Sukeik M., Haddad F.S. Two-stage revision for periprosthetic hip and knee joint infections. Open Orthop J. 2016;10:579-588. doi: 10.2174/1874325001610010579.
  2. Линник С.А., Квиникадзе Г.Э., Кравцов Д.В., Афиногенов Г.Е., Афиногенова. А.Г., Спиридонова А.А. и др. Обоснование выбора спейсера при лечении поздней перипротезной инфекции области тазобедренного сустава. Профилактическая и клиническая медицина. 2019;(3):79-85.
  3. 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.e1. doi: 10.1016/j.arth.2012.02.022.
  4. Gwam C.U., Mistry J.B., Mohamed N.S., Thomas M., Bigart K.C., Mont M.A. et al. Current Epidemiology of Revision Total Hip Arthroplasty in the United States: National Inpatient Sample 2009 to 2013. J Arthroplasty. 2017;32(7):2088-2092. doi: 10.1016/j.arth.2017.02.046.
  5. Charette R.S., Melnic C.M. Two-stage revision arthroplasty for the treatment of prosthetic joint infection. Curr Rev Musculoskelet Med. 2018;11(3):332-340. doi: 10.1007/s12178-018-9495-y.
  6. Ермаков А.М., Клюшин Н.М., Абабков Ю.В., Тряпичников А.С., Коюшков А.Н. Оценка эффективности двухэтапного хирургического лечения больных с перипротезной инфекцией коленного и тазобедренного суставов. Гений ортопедии. 2018;24(3):321-326. doi: 10.18019/1028-4427-2018-24-3-321-326
  7. Середа А.П. Современные пероральные препараты для профилактики тромбоэмболических осложнений – критический обзор доказательной базы в контексте соотношения риск/ польза. Гений ортопедии. 2019;25(3):424-428. doi: 10.18019/1028-4427-2019-25-3-424-428.
  8. Касимова А.Р., Божкова С.А. Применение различных групп лекарственных средств для фармакологической тромбопрофилактики после больших ортопедических операций в клинической практике. Флебология. 2018;12(4):306-313. doi: 10.17116/flebo201812041306.
  9. Agaba P., Kildow B.J., Dhotar H., Seyler T.M., Bolognesi M. Comparison of postoperative complications after total hip arthroplasty among patients receiving aspirin, enoxaparin, warfarin, and factor Xa inhibitors. J Orthop. 2017;14(4):537-543. doi: 10.1016/j.jor.2017.08.002.
  10. Lieberman J.R., Heckmann N. Venous thromboembolism prophylaxis in total hip arthroplasty and total knee arthroplasty patients: from guidelines to practice. J Am Acad Orthop Surg. 2017;25(12):789-798. doi: 10.5435/JAA OS-D-15-00760.
  11. Профилактика венозных тромбоэмболических осложнений в травматологии и ортопедии. Российские клинические рекомендации. Травматология и ортопедия России. 2012;1(Приложение):1-24. doi: 10.21823/2311-2905-2012-0-1.
  12. Otto-Lambertz C., Yagdiran A., Wallscheid F., Eysel P., Jung N. Periprosthetic infection in joint replacement. Dtsch Arztebl Int. 2017;114(20):347-353. doi: 10.3238/arztebl.2017.0347.
  13. Мурылев В., Куковенко Г., Елизаров П., Рукин Я., Цыгин Н. Перипротезная инфекция при эндопротезировании тазобедренного сустава. Врач. 2018;29(3):17-22. doi: 10.29296/25877305-2018-03-04.
  14. Sharqzad A.S., Cavalheiro C., Zahar A., Lausmann C., Gehrke T., Kendoff D. et al. Blood loss and allogeneic transfusion for surgical treatment of periprosthetic joint infection: a comparison of one- vs. two-stage exchange total hip arthroplasty. Int Orthop. 2019;43(9):2025-2030. doi: 10.1007/s00264-018-4137-y.
  15. Zhou X.D., Li J., Xiong Y., Jiang L.F., Li W.J., Wu L.D. Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop. 2013;37(11):2109-2118. doi: 10.1007/s00264-013-2053-8.
  16. Ахтямов И.Ф., Кузьмин И.И., Кузьмин О.И., Кислицын М.А. Роль аспирационного дренирования при эндопротезировании тазобедренного сустава. Казанский медицинский журнал. 2005;86(6):493-497.
  17. 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(12):4-8.
  18. Hsieh P.H., Huang K.C., Tai C.L. Liquid gentamicin in bone cement spacers: in vivo antibiotic release and systemic safety in two-stage revision of infected hip arthroplasty. J Trauma. 2009;66(3):804-808. doi: 10.1097/TA.0b013e31818896cc.
  19. Singh V.A., Wei C.C., Haseeb A., Shanmugam R., Ju C.S. JectOS® versus PMMA vancomycin-loaded cement: The biomechanical and antimicrobial properties. J Orthop Surg (Hong Kong). 2019;27(1):2309499018822247. doi: 10.1177/2309499018822247.
  20. Li C., Renz N., Trampuz A. Management of periprosthetic joint infection. Hip Pelvis. 2018;30(3):138-146. doi: 10.5371/hp.2018.30.3.138.
  21. Затевахин И.И., Пасечник И.Н., Губайдуллин P.P., Решетников Е.А., Березенко М.Н. Ускоренное восстановление после хирургических операций: мультидисциплинарная проблема. Часть 1. Хирургия. Журнал им. Н.И. Пирогова. 2015;(9):4-8. doi: 10.17116/hirurgia201594-8.
  22. Hansen T.B. Fast track in hip arthroplasty. EFORT Open Rev. 2017;2(5):179-188. doi: 10.1302/2058-5241.2.160060.
  23. Kozek-Langenecker S.A., Afshari A., Albaladejo P., Santullano C.A., De Robertis E., Filipescu D.C. et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013;30(6):270-382. doi: 10.1097/EJA.0b013e32835f4d5b.
  24. Jacobs J.J., Mont M.A., Bozic K.J., Della Valle C.J., Goodman S.B., Lewis C.G. et. al. American Academy of Orthopaedic Surgeons clinical practice guideline on: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Bone Joint Surg Am. 2012;94(8):746-747. doi: 10.2106/JBJS.9408.ebo746.
  25. Зиатдинов Б.Г., Ахтямов И.Ф., Садыков Р.И. Современные возможности профилактики тромбоэмболических осложнений при эндопротезировании крупных суставов нижних конечностей. Практическая медицина. 2015;4-1(89):66-70.
  26. Xu H., Xie J., Lei Y., Huang Q., Huang Z., Pei F. Closed suction drainage following routine primary total joint arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a retrospective cohort study. J Orthop Surg Res. 2019;14(1):163. doi: 10.1186/s13018-019-1211-0.
  27. Тихилов Р.М., Серебряков А.Б., Шубняков И.И., Плиев Д.Г., Шильников В.А., Денисов А.О. и др. Влияние различных факторов на кровопотерю при эндопротезировании тазобедренного сустава. Травматология и ортопедия России. 2012;3(65):5-11. doi: 10.21823/2311-2905-2012--3-5-11.
  28. Greenky M., Gandhi K., Pulido L., Restrepo C., Parvizi J. Preoperative anemia in total joint arthroplasty: is it associated with periprosthetic joint infection? Clin Orthop Relat Res. 2012;470(10):2695-2701. doi: 10.1007/s11999-012-2435-z.
  29. Bozic K.J., Lau E., Kurtz S., Ong K., Rubash H., Vail T.P. et al. Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. J Bone Joint Surg Am. 2012;94(9):794-800. doi: 10.2106/JBJS.K.00072.
  30. Swenson R.D., Butterfield J.A., Irwin T.J., Zurlo J.J., Davis C.M. Preoperative anemia is associated with failure of open debridement polyethylene exchange in acute and acute hematogenous prosthetic joint infection. J Arthroplasty. 2018;33(6):1855-1860. doi: 10.1016/j.arth.2018.01.042.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c)


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies