Skip to main content

Advertisement

SpringerLink
Log in

Comparison of patient reported outcome measures after single versus two-stage revision for chronic infection of total hip arthroplasty: a retrospective propensity score matched cohort study

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Two-stage revision is the current gold standard treatment for infected total hip arthroplasties (THA) with good clinical outcomes. Single-stage revision THA offers the advantage of only a single surgical intervention, potentially leading to improved functional outcomes. This study aimed to compare the differences in patient-reported outcome measures (PROMs) and complications between single and two-stage revision THA for chronic periprosthetic joint infection (PJI).

Methods

A total of 159 consecutive revision THA patients for chronic PJI with complete pre-and post-operative patient-reported outcome measures (PROM) was investigated. A total of 46 patients with single-stage revision THA was matched to 92 patients following two-stage revision THA using propensity score matching, yielding a total of 136 propensity score-matched patients for analysis.

Results

Single and two-stage revision THA improved PROM scores post-operatively, with significantly higher PROMs for single-stage revision THA (HOOS-PS: 50.7 vs 46.4, p = 0.04; Physical SF 10A: 42.1 vs 36.6, p < 0.001; PROMIS SF Physical: 41.4 vs 37.4, p < 0.001; PROMIS SF Mental: 52.8 vs 47.6, p < 0.001). There was no significant difference between both cohorts for reinfection rates (p = 0.81) and 90-day mortality rates (p = 1.0).

Conclusion

This study found a demonstrable functional benefit of single-stage revision compared to two-stage revision for THA with chronic periprosthetic joint infection, suggesting that single-stage revision THA may provide an effective alternative to two-stage revision in selected patients with chronic PJI.

Level of evidence

Level III, case-control retrospective analysis

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. George DA, Konan S, Haddad FS (2015) Single-stage hip and knee exchange for periprosthetic joint infection. J Arthroplasty 30:2264–2270. https://doi.org/10.1016/j.arth.2015.05.047

    Article  PubMed  Google Scholar 

  2. Tande AJ, Patel R (2014) Prosthetic joint infection. Clin Microbiol Rev 27:302–345. https://doi.org/10.1128/CMR.00111-13

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Kapadia BH, Berg RA, Daley JA et al (2016) Periprosthetic joint infection. Lancet

  4. Kilgus S, Karczewski D, Passkönig C et al (2020) Failure analysis of infection persistence after septic revision surgery: a checklist algorithm for risk factors in knee and hip arthroplasty. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03444-0

    Article  PubMed  Google Scholar 

  5. Klemt C, Smith EJ, Tirumala V et al (2020) Outcomes and risk factors associated with 2-stage reimplantation requiring an interim spacer exchange for periprosthetic joint infection. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.09.012

    Article  PubMed  Google Scholar 

  6. Klemt C, Tirumala V, Smith EJ et al (2020) Development of a preoperative risk calculator for re-infection following revision surgery for periprosthetic joint infection. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.08.004

    Article  PubMed  Google Scholar 

  7. Bozic KJ, Ries MD (2005) The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. JBJS 87:1746–1751

    Google Scholar 

  8. Kurtz SM, Lau E, Watson H et al (2012) Economic burden of periprosthetic joint infection in the united states. J Arthroplasty. https://doi.org/10.1016/j.arth.2012.02.022

    Article  PubMed  Google Scholar 

  9. Ji B, Wahafu T, Li G et al (2019) Single-stage treatment of chronically infected total hip arthroplasty with cementless reconstruction: results in 126 patients with broad inclusion criteria. Bone Jt J 101-B:396–402. https://doi.org/10.1302/0301-620X.101B4.BJJ-2018-1109.R1

    Article  CAS  Google Scholar 

  10. Pangaud C, Ollivier M, Argenson J-N (2019) Outcome of single-stage versus two-stage exchange for revision knee arthroplasty for chronic periprosthetic infection. EFORT Open Rev 4:495–502. https://doi.org/10.1302/2058-5241.4.190003

    Article  PubMed  PubMed Central  Google Scholar 

  11. Anagnostakos K, Meyer C (2019) Partial two-stage exchange at the site of periprosthetic hip joint infections. Arch Orthop Trauma Surg 139:869–876. https://doi.org/10.1007/s00402-019-03180-0

    Article  PubMed  Google Scholar 

  12. Luu A, Syed F, Raman G et al (2013) Two-stage arthroplasty for prosthetic joint infection: a systematic review of acute kidney injury, systemic toxicity and infection control. J Arthroplasty. https://doi.org/10.1016/j.arth.2013.02.035

    Article  PubMed  Google Scholar 

  13. Berend KR, Lombardi AVJ, Morris MJ et al (2013) Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res 471:510–518. https://doi.org/10.1007/s11999-012-2595-x

    Article  PubMed  Google Scholar 

  14. Klemt C, Tirumala V, Oganesyan R et al (2020) Single-stage revision of the infected total knee arthroplasty is associated with improved functional outcomes: a propensity score matched cohort study. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.07.012

    Article  PubMed  Google Scholar 

  15. Gehrke T, Kendoff D (2012) Peri-prosthetic hip infections: in favour of one-stage. Hip Int 22:40–45

    Article  Google Scholar 

  16. Stoiber A, Winkler H, Winter F et al (2008) One stage uncemented revision of infected total hip replacement using cancellous allograft bone impregnated with antibiotics. J Bone Jt Surg Br. https://doi.org/10.1302/0301-620x.90b12.20742

    Article  Google Scholar 

  17. Klouche S, Leonard P, Zeller V et al (2012) Infected total hip arthroplasty revision: one- or two-stage procedure? Orthop Traumatol Surg Res 98:144–150. https://doi.org/10.1016/j.otsr.2011.08.018

    Article  CAS  PubMed  Google Scholar 

  18. Kurtz S, Ong K, Lau E et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surg Am 89:780–785. https://doi.org/10.2106/JBJS.F.00222

    Article  Google Scholar 

  19. Mahomed NN, Arndt DC, McGrory BJ, Harris WH (2001) The Harris hip score: comparison of patient self-report with surgeon assessment. J Arthroplasty 16:575–580

    Article  CAS  Google Scholar 

  20. Davis AM, Perruccio AV, Canizares M et al (2009) Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for osteoarthritis. Osteoarthr Cartil 17:843–847. https://doi.org/10.1016/j.joca.2009.01.005

    Article  CAS  Google Scholar 

  21. Wylde V, Learmonth ID, Cavendish VJ (2005) The Oxford hip score: the patient’s perspective. Health Qual Life Outcomes 3:66. https://doi.org/10.1186/1477-7525-3-66

    Article  PubMed  PubMed Central  Google Scholar 

  22. Cella D, Riley W, Stone A et al (2010) The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol 63:1179–1194. https://doi.org/10.1016/j.jclinepi.2010.04.011

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fehring KA, Abdel MP, Ollivier M et al (2017) Repeat two-stage exchange arthroplasty for periprosthetic knee infection is dependent on host grade. J Bone Jt Surg Am 99:19–24. https://doi.org/10.2106/JBJS.16.00075

    Article  Google Scholar 

  24. Parvizi J, Tan TL, Goswami K et al (2018) Knee. J Arthroplasty 33:1309-1314.e2. https://doi.org/10.1016/j.arth.2018.02.078

    Article  PubMed  Google Scholar 

  25. Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Jt J 95-B:1450–1452. https://doi.org/10.1302/0301-620X.95B11.33135

    Article  CAS  Google Scholar 

  26. Haddad FS, Sukeik M, Alazzawi S (2015) Is single-stage revision according to a strict protocol effective in treatment of chronic knee arthroplasty infections? Clin Orthop Relat Res 473:8–14. https://doi.org/10.1007/s11999-014-3721-8

    Article  PubMed  Google Scholar 

  27. Bauer T, Piriou P, Lhotellier L et al (2006) Results of reimplantation for infected total knee arthroplasty: 107 cases. Rev Chir Orthop Reparatrice Appar Mot 92:692–700

    Article  CAS  Google Scholar 

  28. George J, Miller EM, Curtis GL et al (2018) Success of two-stage reimplantation in patients requiring an interim spacer exchange. J Arthroplasty 33:S228–S232. https://doi.org/10.1016/j.arth.2018.03.038

    Article  PubMed  Google Scholar 

  29. Davis AM, Perruccio AV, Canizares M et al (2008) The development of a short measure of physical function for hip OA HOOS-Physical Function Shortform (HOOS-PS): an OARSI/OMERACT initiative. Osteoarthr Cartil 16:551–559. https://doi.org/10.1016/j.joca.2007.12.016

    Article  CAS  Google Scholar 

  30. Ramkumar PN, Harris JD, Noble PC (2015) Patient-reported outcome measures after total knee arthroplasty: a systematic review. Bone Jt Res 4:120–127. https://doi.org/10.1302/2046-3758.47.2000380

    Article  CAS  Google Scholar 

  31. Nilsdotter AK, Lohmander LS, Klässbo M, Roos EM (2003) Hip disability and osteoarthritis outcome score (HOOS)—validity and responsiveness in total hip replacement. BMC Musculoskelet Disord. https://doi.org/10.1186/1471-2474-4-10

    Article  PubMed  PubMed Central  Google Scholar 

  32. Yost KJ, Eton DT, Garcia SF, Cella D (2011) Minimally important differences were estimated for six patient-reported outcomes measurement information system-cancer scales in advanced-stage cancer patients. J Clin Epidemiol 64:507–516. https://doi.org/10.1016/j.jclinepi.2010.11.018

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bonner BE, Castillo TN, Fitz DW et al (2019) Preoperative opioid use negatively affects patient-reported outcomes after primary total hip arthroplasty. J Am Acad Orthop Surg. https://doi.org/10.5435/JAAOS-D-18-00658

    Article  PubMed  Google Scholar 

  34. Mendez JH, Mehrani A, Randolph P, Stagg S (2019) Throughput and resolution with a next-generation direct electron detector. IUCrJ 6:1007–1013. https://doi.org/10.1107/S2052252519012661

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Bozic KJ, Kurtz S, Lau E et al (2009) The epidemiology of bearing surface usage in total hip arthroplasty in the United States. J Bone Jt Surg Am 91:1614–1620. https://doi.org/10.2106/JBJS.H.01220

    Article  Google Scholar 

  36. Bozic KJ, Kurtz SM, Lau E et al (2010) The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 468:45–51. https://doi.org/10.1007/s11999-009-0945-0

    Article  PubMed  Google Scholar 

  37. Hsieh P-H, Shih C-H, Chang Y-H et al (2004) Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. JBJS 86:1989–1997

    Article  Google Scholar 

  38. Kandel CE, Jenkinson R, Daneman N et al (2019) Predictors of treatment failure for hip and knee prosthetic joint infections in the setting of 1- and 2-stage exchange arthroplasty: a multicenter retrospective cohort. Open forum Infect Dis 6:4fc452. https://doi.org/10.1093/ofid/ofz452

    Article  Google Scholar 

  39. Singer J, Merz A, Frommelt L, Fink B (2012) High rate of infection control with one-stage revision of septic knee prostheses excluding MRSA and MRSE. Clin Orthop Relat Res 470:1461–1471. https://doi.org/10.1007/s11999-011-2174-6

    Article  PubMed  Google Scholar 

  40. van den Kieboom J, Tirumala V, Xiong L et al (2021) Concomitant hip and knee periprosthetic joint infection in periprosthetic fracture: diagnostic utility of serum and synovial fluid markers. J Arthroplasty 36:722–727. https://doi.org/10.1016/j.arth.2020.08.029

    Article  PubMed  Google Scholar 

  41. Oussedik SIS, Dodd MB, Haddad FS (2010) Outcomes of revision total hip replacement for infection after grading according to a standard protocol. J Bone Jt Surg Br 92-B:1222–1226. https://doi.org/10.1302/0301-620x.92b9.23663

    Article  Google Scholar 

  42. Maier SP, Klemt C, Tirumala V et al (2020) Elevated ESR/CRP ratio is associated with reinfection after debridement, antibiotics, and implant retention in chronic periprosthetic joint infections. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.06.007

    Article  PubMed  Google Scholar 

  43. Ntalos D, Berger-Groch J, Rohde H et al (2019) Implementation of a multidisciplinary infections conference affects the treatment plan in prosthetic joint infections of the hip: a retrospective study. Arch Orthop Trauma Surg 139:467–473. https://doi.org/10.1007/s00402-018-3079-6

    Article  PubMed  Google Scholar 

  44. Bourne RB (2008) Measuring tools for functional outcomes in total knee arthroplasty. Clin Orthop Relat Res 466:2634–2638

    Article  Google Scholar 

  45. Ostendorf M, Van Stel HF, Buskens E et al (2004) Patient-reported outcome in total hip replacement: a comparison of five instruments of health status. J Bone Jt Surg Br 86:801–808

    Article  CAS  Google Scholar 

  46. Rolfson O, Malchau H (2015) The use of patient-reported outcomes after routine arthroplasty: beyond the whys and ifs. Bone Jt J 97-B:578–581. https://doi.org/10.1302/0301-620x.97b5.35356

    Article  CAS  Google Scholar 

  47. Wolf CF, Gu NY, Doctor JN et al (2011) Comparison of one and two-stage revision of total hip arthroplasty complicated by infection: a Markov expected-utility decision analysis. JBJS 93:631–639

    Article  Google Scholar 

  48. De Man FHR, Sendi P, Zimmerli W et al (2011) Infectiological, functional, and radiographic outcome after revision for prosthetic hip infection according to a strict algorithm: 22 one-stage and 50 two-stage revisions with a mean follow-up time of 5 (2–17) years. Acta Orthop 82:27–34

    Article  Google Scholar 

  49. Rustenburg CME, Verberne SJ, Peters EJG et al (2018) Results and patient reported outcome measures (PROMs) after one-stage revision for periprosthetic joint infection of the hip: a single-centre retrospective study. J Bone Jt Infect 3:143–149. https://doi.org/10.7150/jbji.24366

    Article  PubMed  PubMed Central  Google Scholar 

  50. Hung M, Bounsanga J, Voss MW, Saltzman CL (2018) Establishing minimum clinically important difference values for the patient-reported outcomes measurement information system physical function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis outcome score for joint reconstruction in orthopaedics. World J Orthop 9:41–49. https://doi.org/10.5312/wjo.v9.i3.41

    Article  PubMed  PubMed Central  Google Scholar 

  51. Hossain FS, Konan S, Patel S et al (2015) The assessment of outcome after total knee arthroplasty: are we there yet? Bone Jt J 97:3–9

    Article  Google Scholar 

  52. Whitehouse JD, Friedman ND, Kirkland KB et al (2002) The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 23:183–189

    Article  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Venkatsaiakhil Tirumala, Christian Klemt, Janna van den Kieboom, Liang Xiong & Young-Min Kwon

Authors
  1. Venkatsaiakhil Tirumala
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian Klemt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Janna van den Kieboom
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Liang Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Young-Min Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Young-Min Kwon.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained for the retrospective patient chart review.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tirumala, V., Klemt, C., van den Kieboom, J. et al. Comparison of patient reported outcome measures after single versus two-stage revision for chronic infection of total hip arthroplasty: a retrospective propensity score matched cohort study. Arch Orthop Trauma Surg 141, 1789–1796 (2021). https://doi.org/10.1007/s00402-021-03810-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-021-03810-6

Keywords

Search

Navigation