Treatment of Early Postoperative Infections after THA: A Decision Analysis
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
The treatment for an early postoperative periprosthetic infection after cementless THA that results in the highest quality of life after the control of infection is unknown. Although common treatments include irrigation and débridement with component retention, a one-stage exchange, or a two-stage exchange, it is unclear whether any of these provides a higher quality of life after the control of infection.
We projected, through decision-analysis modeling, the possible estimated final health states defined as health-related quality of life based on quality-of-life studies of an early postoperative periprosthetic infection after cementless THA treated by irrigation and débridement, one-stage exchange, or two-stage exchange.
Publications addressing early postoperative infections after THA were analyzed for the estimated rate of infection control and quality-of-life measures after a specific treatment. Decision analysis was used to model the different treatments and describe which, if any, treatment results in the greatest quality of life after early THA infection.
In the model, a one-stage exchange was the treatment for early THA infection that maximized quality-of-life outcomes if the probability of controlling the infection exceeded 66% with this procedure. If the probability of infection control of a one-stage exchange was less than 66% or that of irrigation and débridement was greater than 60%, then irrigation and débridement appeared to result in the greatest quality-of-life outcome.
A decision analysis using estimates of infection control rate and quality-of-life outcomes after different treatments for an early postoperative infection after THA showed possible outcomes for each treatment.
Level of Evidence
Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.
- Bauer TW, Parvizi J, Kobayashi N, Krebs V. Diagnosis of periprosthetic infection. J Bone Joint Surg Am. 2006;88:869–882. CrossRef
- Bozic KJ, Morshed S, Silverstein MD, Rubash HE, Kahn JG. Use of cost-effectiveness analysis to evaluate new technologies in orthopaedics: the case of alternative bearing surfaces in total hip arthroplasty. J Bone Joint Surg Am. 2006;88:706–714. CrossRef
- Bozic KJ, Rubash HE, Sculco TP, Berry DJ. An analysis of medicare payment policy for total joint arthroplasty. J Arthroplasty. 2008;23(6 suppl 1):133–138. CrossRef
- Bratzler DW, Houck PM; Surgical Infection Prevention Guidelines Writers Workgroup; American Academy of Orthopaedic Surgeons; American Association of Critical Care Nurses; American Association of Nurse Anesthetists; American College of Surgeons; American College of Osteopathic Surgeons; American Geriatrics Society; American Society of Anesthesiologists; American Society of Colon and Rectal Surgeons; American Society of Health-System Pharmacists; American Society of PeriAnesthesia Nurses; Ascension Health; Association of periOperative Registered Nurses; Association for Professionals in Infection Control and Epidemiology; Infectious Diseases Society of America; Medical Letter; Premier; Society for Healthcare Epidemiology of America; Society of Thoracic Surgeons; Surgical Infection Society. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004;38:1706–1715.
- Callaghan JJ, Katz RP, Johnston RC. One-stage revision surgery of the infected hip: a minimum 10-year followup study. Clin Orthop Relat Res. 1999;369:139–143. CrossRef
- Charnley J. Postoperative infection after total hip replacement with special reference to air contamination in the operating room. Clin Orthop Relat Res. 1972;87:167–187. CrossRef
- Charnley J, Eftekhar N. Postoperative infection in total prosthetic replacement arthroplasty of the hip-joint: with special reference to the bacterial content of the air of the operating room. Br J Surg. 1969;56:641–649. CrossRef
- Crockarell JR, Hanssen AD, Osmon DR, Morrey BF. Treatment of infection with debridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am. 1998;80:1306–1313.
- Cummins JS, Tomek IM, Kantor SR, Furnes O, Engesaeter LB, Finlayson SR. Cost-effectiveness of antibiotic-impregnated bone cement used in primary total hip arthroplasty. J Bone Joint Surg Am. 2009;91:634–641. CrossRef
- Fehring TK, Calton TF, Griffin WL. Cementless fixation in 2-stage reimplantation for periprosthetic sepsis. J Arthroplasty. 1999;14:175–181. CrossRef
- Fisman DN, Reilly DT, Karchmer AW, Goldie SJ. Clinical effectiveness and cost-effectiveness of 2 management strategies for infected total hip arthroplasty in the elderly. Clin Infect Dis. 2001;32:419–430. CrossRef
- Garvin KL, Hanssen AD. Infection after total hip arthroplasty: past, present, and future. J Bone Joint Surg Am. 1995;77:1576–1588.
- Haddad FS, Muirhead-Allwood SK, Manktelow AR, Bacarese-Hamilton I. Two-stage uncemented revision hip arthroplasty for infection. J Bone Joint Surg Br. 2000;82:689–694. CrossRef
- Hanssen AD, Spangehl MJ. Treatment of the infected hip replacement. Clin Orthop Relat Res. 2004;420:63–71. CrossRef
- Jackson WO, Schmalzried TP. Limited role of direct exchange arthroplasty in the treatment of infected total hip replacements. Clin Orthop Relat Res. 2000;381:101–105. CrossRef
- Kraay MJ, Goldberg VM, Fitzgerald SJ, Salata MJ. Cementless two-staged total hip arthroplasty for deep periprosthetic infection. Clin Orthop Relat Res. 2005;441:243–249. CrossRef
- Kurtz SM, Ong KL, Schmier J, Mowat F, Saleh K, Dybvik E, Karrholm J, Garellick G, Havelin LI, Furnes O, Malchau H, Lau E. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am. 2007;89(suppl 3):144–151. CrossRef
- Laupacis A, Bourne R, Rorabeck C, Feeny D, Wong C, Tugwell P, Leslie K, Bullas R. The effect of elective total hip replacement on health-related quality of life. J Bone Joint Surg Am. 1993;75:1619–1626.
- Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Rates and outcomes of primary and revision total hip replacement in the United States medicare population. J Bone Joint Surg Am. 2003;85:27–32.
- Malchau H, Herberts P, Ahnfelt L. Prognosis of total hip replacement in Sweden: follow-up of 92,675 operations performed 1978-1990. Acta Orthop Scand. 1993;64:497–506. CrossRef
- Marculescu CE, Berbari EF, Hanssen AD, Steckelberg JM, Harmsen SW, Mandrekar JN, Osmon DR. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis. 2006;42:471–478. CrossRef
- Pagnano MW, Trousdale RT, Hanssen AD. Outcome after reinfection following reimplantation hip arthroplasty. Clin Orthop Relat Res. 1997;338:192–204. CrossRef
- Phillips CB, Barrett JA, Losina E, Mahomed NN, Lingard EA, Guadagnoli E, Baron JA, Harris WH, Poss R, Katz JN. Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. J Bone Joint Surg Am. 2003;85:20–26. CrossRef
- Rasanen P, Paavolainen P, Sintonen H, Koivisto AM, Blom M, Ryynanen OP, Roine RP. Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthop. 2007;78:108–115. CrossRef
- Raut VV, Siney PD, Wroblewski BM. One-stage revision of total hip arthroplasty for deep infection: long-term followup. Clin Orthop Relat Res. 1995;321:202–207.
- Raut VV, Siney PD, Wroblewski BM. One stage revision arthroplasty of the hip for deep gram negative infection. Int Orthop. 1996;20:12–14. CrossRef
- Salvati EA, Robinson RP, Zeno SM, Koslin BL, Brause BD, Wilson PD Jr. Infection rates after 3175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered air-flow system. J Bone Joint Surg Am. 1982;64:525–535.
- Schmalzried TP. The infected hip: telltale signs and treatment options. J Arthroplasty. 2006;21(4 suppl 1):97–100 CrossRef
- Schultz WR, Weinstein JN, Weinstein SL, Smith BG. Prophylactic pinning of the contralateral hip in slipped capital femoral epiphysis: evaluation of long-term outcome for the contralateral hip with use of decision analysis. J Bone Joint Surg Am. 2002;84:1305–1314.
- Slover J, Espehaug B, Havelin LI, Engesaeter LB, Furnes O, Tomek I, Tosteson A. Cost-effectiveness of unicompartmental and total knee arthroplasty in elderly low-demand patients: a Markov decision analysis. J Bone Joint Surg Am. 2006;88:2348–2355. CrossRef
- Sporer SM, Rosenberg AG. Decision analysis in orthopaedics. Clin Orthop Relat Res. 2005;431:250–256. CrossRef
- The Center for the Evaluation of Value and Risk in Health (CEVR). The Cost-Effectiveness Analysis Registry. Institute for Clinical Research & Health Policy Studies, Tufts Medical Center; 2009. Available at: http://www.cearegistry.org. Accessed June 6, 2011.
- Toms AD, Davidson D, Masri BA, Duncan CP. The management of peri-prosthetic infection in total joint arthroplasty. J Bone Joint Surg Br. 2006;88:149–155.
- Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty: a study of the treatment of one hundred and six infections. J Bone Joint Surg Am. 1996;78:512–523.
- Winkler H, Stoiber A, Kaudela K, Winter F, Menschik F. One stage uncemented revision of infected total hip replacement using cancellous allograft bone impregnated with antibiotics. J Bone Joint Surg Br. 2008;90:1580–1584. CrossRef
- Wroblewski BM. One-stage revision of infected cemented total hip arthroplasty. Clin Orthop Relat Res. 1986;211:103–107.
- Younger AS, Duncan CP, Masri BA, McGraw RW. The outcome of two-stage arthroplasty using a custom-made interval spacer to treat the infected hip. J Arthroplasty. 1997;12:615–623. CrossRef
- Treatment of Early Postoperative Infections after THA: A Decision Analysis
Clinical Orthopaedics and Related Research®
Volume 469, Issue 12 , pp 3477-3485
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- 2. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- 3. Department of Orthopaedic Surgery, Philip R. Lee Institute for Health Policy, University of California, San Francisco, San Francisco, CA, USA