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Clinical impact of microbiological results in two-stage revision arthroplasty with spacer exchange

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

Abstract

Introduction

Patients who require a spacer exchange as part of a two-stage procedure for the treatment of periprosthetic hip and knee joint infections (PJI) have high failure rates. Little is known about the clinical impact of microbiological results and changes in the microbiological spectrum and resistance pattern in these patients.

Material and Methods

Between 01/2011 and 12/2019, 312 patients underwent a total of 327 two-stage revision arthroplasties at our institution. A spacer exchange was required in 52/312 (16.7%) patients (27 knee/25 hip). Microbiological results, antibiotic resistance patterns, patient’s host factors as well as re-revision and re-infection rates at a median follow-up of 47.8 months (range 12.2–116.7 months) were analyzed. A propensity score (PS)-matched analysis of patients who underwent spacer exchange and patients treated with standard two-stage procedure was performed.

Results

We found a high number of microbiological spectrum changes in patients with multiple culture positive procedures between explantations and spacer exchanges (10/12 [83.3%]), spacer exchanges and reimplantations (3/4 [75%]) as well as between reimplantations and subsequent re-revision surgeries (5/6 [83.3%]). In 9/52 (17.3%) patients, same microorganisms were detected repeatedly in two different procedures. We observed changes in the antibiotic resistance patterns in 6/9 (66.7%) of these patients. High re-infection rates were found in patients with culture positive reimplantations (10/12 [83.3%]), and low re-infection rates were found in patients with culture negative reimplantations (2/40 [5%]; p < 0.001). Between patients with and without spacer exchange, no differences were found in the re-revision rates (13/52 [25%] with vs. 13/52 [25%] without; p = 1.00) as well as re-infection rates (12/52 [23.1%] with vs. 8/52 [15.4%] without; p = 0.32).

Conclusions

Changes in microbiological spectrum and antibiotic resistance patterns between stages are common in patients who require a spacer exchange. If eradication of the microorganism at reimplantation can be accomplished, comparable re-revision rates to standard two-stage procedures can be achieved.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Acknowledgements

We would like to thank Christina Schober and Dr. Mojgan Prinz for their support in the development of this document and their kind support in data collection.

Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Speisinger Strasse 109, 1130, Vienna, Austria

    Bernhard J. H. Frank, Sebastian Simon, Alexander Aichmair & Jochen G. Hofstaetter

  2. 2nd Department, Orthopaedic Hospital Vienna-Speising, Speisinger Strasse 109, 1130, Vienna, Austria

    Bernhard J. H. Frank, Sebastian Simon, Alexander Aichmair, Martin Dominkus & Jochen G. Hofstaetter

  3. School of Medicine, Sigmund Freud University Vienna, Freudplatz 1, 1020, Vienna, Austria

    Martin Dominkus

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by BJHF, SS, MD, JGH and AA. The first draft of the manuscript was written by BJHF, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jochen G. Hofstaetter.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Our study was performed in accordance with the 1964 Declaration of Helsinki and was approved by our institutional review board (Ethics Committee of the Vienna Hospitals of the Vinzenz Group). The Ethics Committee reference number is ‘EK 04/2021.’

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Frank, B.J.H., Simon, S., Aichmair, A. et al. Clinical impact of microbiological results in two-stage revision arthroplasty with spacer exchange. Arch Orthop Trauma Surg 143, 4741–4754 (2023). https://doi.org/10.1007/s00402-023-04770-9

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