Efficiency of Surgical Debridement and Implant Retaining in Treatment of Early Postoperative and Acute Hematogenous Periprosthetic Infections of Hip

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Abstract

Background. Periprosthetic infection is a devastating complication that influences the duration of treatment and patients life quality. Debridement, Antibiotics and Implant Retention (DAIR) is considered as least invasive surgery patients with stable  implant,  except  cases  of  chronical  periprosthetic  infection. The  aim  of  this  study was  to  evaluate  efficiency  of surgical debridement and implant retaining in control over infection in group patients with early postoperative and acute hematogenous periprosthetic infections. Materials and Methods.We performed retrospective monocentral cohort study of treatment early postoperative and acute hematogenous periprosthetic infections of hip in 26 patients. The group included cases with stable implants and period between manifestation of infection and DAIR no more than 4 weeks. We have classified infection as early postoperative in 22 patients (84,2%) and as acute hematogenous in 4 cases (15,8%). Results.At mean follow-up 42,8±2,3 mounts five patients underwent removal of implant due to reinfection. We performed successful twostage revision for four of them and had to perform resection arthroplasty in one case. Thus, DAIR protocol was successful in 80,8(%) cases. The mean Harris Hip Score significantly improved compared to preoperative values from 59,2±2,5 to 80,5±1,3 at the last follow-up (p = 0,0002, Z-3,7). Conclusions.The efficiency of DAIR according to our data was 80,8%. These results allow to consider DAIR as a method of treatment of patients with early postoperative and acute hematogenous periprosthetic infections. Exchange of modular components can decrease the reinfection rate.

About the authors

A. S. Tryapichnikov

Ilizarov National Medical Research Centre for Traumatology and Orthopedics

Author for correspondence.
Email: pich86@bk.ru
ORCID iD: 0000-0001-7305-506X

Aleksandr S. Tryapichnikov— Cand. Sci. (Med.)

Russian Federation

A. M. Ermakov

Ilizarov National Medical Research Centre for Traumatology and Orthopedics

Email: tsyl@mail.ru
ORCID iD: 0000-0002-5420-4637

Artem M. Ermakov— Cand. Sci. (Med.)

T. A. Silantieva

Ilizarov National Medical Research Centre for Traumatology and Orthopedics

Email: tsyl@mail.ru
ORCID iD: 0000-0001-6405-8365

Tamara  A.  Silantieva —  Cand.  Sci.  (Med.)

A. V. Burtsev

Ilizarov National Medical Research Centre for Traumatology and Orthopedics

Email: tsyl@mail.ru
ORCID iD: 0000-0001-8968-6528

Alexander V. Burtsev— Dr. Sci. (Med.)

References

  1. Grammatopoulos G, Kendrick B, McNally M, Athanasou NA, Atkins B, McLardy-Smith P, Taylor A, Gundle R. Outcome following debridement, antibiotics, and implant retention in hip periprosthetic joint infection-an 18-year experience. J Arthroplasty. 2017; 32(7):2248-2255. doi: 10.1016/j.arth.2017.02.066. Epub 2017 Mar 6. PMID: 28385345.
  2. Kuiper JW, Willink RT, Moojen DJ, van den Bekerom MP, Colen S. Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts. World J Orthop. 2014 Nov 18;5(5):667-76. doi: 10.5312/wjo.v5.i5.667. PMID: 25405096; PMCID: PMC4133475.
  3. Кочиш А.А., Божкова С.А., Нетылько Г.И., Анисимова Л.И. Экспериментальное исследование эффективности полимерной антимикробной композиции с гемостатическим эффектом в лечении имплантат-ассоциированной инфекции // Гений
  4. ортопедии. 2019. Т. 25, No 2. С. 180-187.doi: 10.18019/1028-4427-2019-25-2-180-1
  5. Kochish A.A., Bozhkova S.A., Netylko G.I., Anisimova L.I. Experimental study of antimicrobial polymeric composition with hemostatic effect in treatment of implant associated infection. Genij Ortopedii. 2019, T. 25, No 2, pp.180-187. doi: 10.18019/1028-4427-2019-25-2-180-187
  6. Губин А.В., Клюшин Н.М. Проблемы организации лечения больных хроническим остеомиелитом и пути их решения на примере создания клиники гнойной остеологии // Гений
  7. ортопедии. 2019. Т. 25, No 2. С. 140-148. doi: 10.18019/1028-4427- 2019-25-2-140-148
  8. Gubin A.V., Kliushin N.M. Organizational issues in management of patients with chronic osteomyelitis and the solutions offered by osteology infection clinic. Genij Ortopedii. 2019, T. 25,No 2, pp. 140-148. doi: 10.18019/1028-4427-2019-25-2-140-148.
  9. Uriarte I, Moreta J, Mosquera J, Legarreta MJ, Aguirre U, Martínez de Los Mozos JL. Debridement, antibiotics and implant retention for early periprosthetic infections of the hip: outcomes and influencing factors. Hip Pelvis. 2019;31(3):158-165. doi: 10.5371/hp.2019.31.3.158
  10. Argenson J.N., Arndt M., Babis G., Battenberg A., Budhiparama N., Catani F., Chen F., de Beaubien B., Ebied A., Esposito S., Ferry C., Flores H., Giorgini A., Hansen E., Hernugrahanto K.D., Hyonmin C., Kim T.K., Koh I.J., Komnos G., Lausmann C., Loloi J., Lora-Tamayo J., Lumban-Gaol I., Mahyudin F., Mancheno-Losa M., Marculescu C., Marei S., Martin K.E., Meshram P., Paprosky W.G., Poultsides L., Saxena A., Schwechter E., Shah J., Shohat N., Sierra R.J., Soriano A., Stefánsdóttir A., Suleiman L.I., Taylor A., Triantafyllopoulos G.K., Utomo D.N., Warren D., Whiteside L., Wouthuyzen-Bakker M., Yombi J., Zmistowski B. Hip and Knee Section, Treatment, Debridement and Retention of Implant: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty. 2019 Feb;34(2S):S399-S419. doi: 10.1016/j.arth.2018.09.025. Epub 2018 Oct 19. PMID: 30348550.
  11. Tsukayama D.T., Estrada R., Gustilo R.B. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J. Bone Joint Surg. Am. 1996; 78(4):512–523.
  12. Яковелли С., Парвизи Д. Кто должен лечить перипротезную инфекцию: необходимость мультидисциплинарного подхода. Травматология и ортопедия России. 2019;25(4):28-32. https://doi.org/10.21823/2311-2905-2019-25-4-28-32
  13. Yacovelli S., Parvizi J. Who Should Manage Periprosthetic Joint Infection? The Case for a Multidisciplinary Approach. Traumatology and Orthopedics of Russia. 2019;25(4):28-32. https://doi.org/10.21823/2311-2905-2019-25-4-28-32
  14. Sukeik M., Patel S., Haddad F.S. Aggressive early débridement for treatment of acutely infected cemented total hip arthroplasty. Clin Orthop Relat Res. 2012 ;470(11):3164-70. doi: 10.1007/s11999-012-2500-7. PMID: 22826016; PMCID: PMC3462872.
  15. Винклер Т., Трампуш А., Ренц Н., Перка К., Божкова С.А. Классификация и алгоритм диагностики и лечения перипротезной инфекции тазобедренного сутсава. Травматология и ортопедия России. 2016;(1):33-45. https://doi.org/10.21823/2311-2905-2016-0-1-33-45
  16. Winkler T., Trampuz A., Renz N., Perka C., Bozhkova S.A. Classification and algorithm for diagnosis and treatment of hip psosthesis joint infection. Traumatology and Orthopedics of Russia. 2016;(1):33-45. (In Russ.) https://doi.org/10.21823/2311-2905-2016-0-1-33-45
  17. Diaz-Ledezma C., Higuera C.A., Parvizi J. Success after treatment of periprosthetic joint infection: a Delphi-based international multidisciplinary consensus. Clin Orthop Relat Res. 2013 Jul;471(7):2374-82. doi: 10.1007/s11999-013-2866-1. Epub 2013 Feb 26. PMID: 23440616; PMCID: PMC3676607.
  18. Westberg M., Grøgaard B., Snorrason F. Early prosthetic joint infections treated with debridement and implant retention: 38 primary hip arthroplasties prospectively recorded and followed for median 4 years. Acta Orthop. 2012 Jun;83(3):227-32. doi: 10.3109/17453674.2012.678801. Epub 2012 Apr 11. PMID: 22489892; PMCID: PMC3369146.
  19. Achermann Y., Stasch P., Preiss S., Lucke K., Vogt M. Characteristics and treatment outcomes of 69 cases with early prosthetic joint infections of the hip and knee. Infection. 2014; 42(3):511-9. doi: 10.1007/s15010-014-0584-6. Epub 2014 Jan 29. PMID: 24474624.
  20. Duijf S.V., Vos F.J., Meis J.F., Goosen J.H. Debridement, antibiotics and implant retention in early postoperative infection with Enterococcus sp. Clin Microbiol Infect. 2015 May;21(5):e41-2. doi: 10.1016/j.cmi.2015.01.006. Epub 2015 Jan 24. PMID: 25748495.
  21. Bergkvist M., Mukka S.S., Johansson L., Ahl T.E., Sayed-Noor A.S., Sköldenberg O.G., Eisler T. Debridement, antibiotics and implant retention in early periprosthetic joint infection. Hip Int. 2016;26(2):138-43. doi: 10.5301/hipint.5000328. Epub 2016 Feb 8. PMID: 26868114.
  22. Jacobs A.M.E., Valkering L.J.J., Bénard M., Meis J.F., Goosen J.H.M. Evaluation one year after DAIR treatment in 91 suspected early prosthetic joint infections in primary knee and hip arthroplasty. J Bone Jt Infect. 2019;4(5):238-244. Published 2019 Oct 15. doi: 10.7150/jbji.37757
  23. Kuiper J.W., Vos S.J., Saouti R., Vergroesen D.A., Graat H.C., Debets-Ossenkopp Y.J., Peters E.J., Nolte P.A. Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention): analysis of risk factors and local antibiotic carriers in 91 patients. Acta Orthop. 2013 (4):380-6. doi: 10.3109/17453674.2013.823589. Epub 2013 Jul 12. PMID: 23848215; PMCID: PMC3768038.
  24. Tsang S.J., Ting J., Simpson A.H.R.W., Gaston P. Outcomes following debridement, antibiotics and implant retention in the management of periprosthetic infections of the hip: a review of cohort studies. Bone Joint J. 2017; 99-B(11):1458-1466. doi: 10.1302/0301-620X.99B11.BJJ-2017-0088.R1. PMID: 29092984.
  25. Manrique J., Komnos G.A., Tan T.L., Sedgh S., Shohat N., Parvizi J. Outcomes of Superficial and Deep Irrigation and Debridement in Total Hip and Knee Arthroplasty. J Arthroplasty. 2019 Jul;34(7):1452-1457. doi: 10.1016/j.arth.2019.03.032. Epub 2019 19. PMID: 30962091.
  26. Choi H.R., von Knoch F., Kandil A.O., Zurakowski D., Moore S., Malchau H. Retention treatment after periprosthetic total hip arthroplasty infection. Int Orthop. 2012 ;36(4):723-9. doi: 10.1007/s00264-011-1324-5. Epub 2011 Jul 27. PMID: 21792609; PMCID: PMC3311804.
  27. Buller L.T., Sabry F.Y., Easton R.W., Klika A.K., Barsoum W.K. The preoperative prediction of success following irrigation and debridement with polyethylene exchange for hip and knee prosthetic joint infections. J Arthroplasty. 2012 ;27(6):857-64.e1-4. doi: 10.1016/j.arth.2012.01.003. Epub 2012 Mar 6. PMID: 22402229.
  28. Triantafyllopoulos G.K., Poultsides L.A., Sakellariou V.I., Zhang W., Sculco P.K., Ma Y., Sculco T.P. Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome. Int Orthop. 2015 Jun;39(6):1203-9. doi: 10.1007/s00264-015-2753-3. Epub 2015 Mar 31. PMID: 25820839.
  29. Betz M., Abrassart S., Vaudaux P., Gjika E., Schindler M., Billières J., Zenelaj B., Suvà D., Peter R., Uçkay I. Increased risk of joint failure in hip prostheses infected with Staphylococcus aureus treated with debridement, antibiotics and implant retention compared to Streptococcus. Int Orthop. 2015 Mar;39(3):397-401. doi: 10.1007/s00264-014-2510-z. Epub 2014 Sep 4. PMID: 25183296.
  30. Bryan A.J., Abdel M.P., Sanders T.L., Fitzgerald S.F., Hanssen A.D., Berry D.J. Irrigation and Debridement with Component Retention for Acute Infection After Hip Arthroplasty: Improved Results with Contemporary Management. J Bone Joint Surg Am. 2017 Dec 6;99(23):2011-2018. doi: 10.2106/JBJS.16.01103. PMID: 29206791.
  31. Hirsiger S., Betz M., Stafylakis D., Götschi T., Lew D., Uçkay I. The Benefice of Mobile Parts' Exchange in the Management of Infected Total Joint Arthroplasties with Prosthesis Retention (DAIR Procedure). J Clin Med. 2019 Feb 9;8(2):226. doi: 10.3390/jcm8020226. PMID: 30744128; PMCID: PMC6407118.

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