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Validity of a preoperative scoring system for surgical management of periprosthetic hip infection: one-stage vs. two-stage revision

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

Abstract

Introduction

There are no widely accepted algorithms for determining optimal treatment for periprosthetic joint infection (PJI). Our study aimed to confirm the validity of a previously published scoring system in a larger number of patients to support a rational surgical treatment strategy for periprosthetic hip infection.

Materials and methods

Between February 2001 and December 2020, we performed 155 consecutive revision total hip arthroplasties (THAs) for PJI, with mean follow-up of 6 years. One-stage revision THA was performed in 56 hips and two-stage revision THA in 99 hips. Prosthesis survival from recurrent infection was determined by Kaplan-Meier analysis, using implant removal as the endpoint. The pre-operative scoring system (full score of 12 points), including 6 essential elements, was retrospectively evaluated.

Results

The 10-year survival rates were 98% for one-stage (95% confidence interval [CI], 94–100) and 87% (95% CI, 79–96) for two-stage revision THA. Multivariate Cox regression analysis provided a total preoperative score as an independent risk factor for implant removal (hazard ratio, 0.17; 95% CI, 0.06–0.49; p < 0.001). The sensitivity and specificity at the cut-off of 4 points on the scoring system were 80% and 91%, respectively. The average score for one-stage revision THA in successful and failed cases were 8.9 and 6.0, and for two-stage revision THA were 6.5 and 3.9, respectively. We found significant differences between successful cases in one- and two-stage revision THA (p < 0.05).

Conclusions

The preoperative scoring system was useful for managing PJI. One-stage revision THA is recommended in patients scoring ≥ 9 points, and meticulously performed two-stage revision THA is encouraged for patients scoring ≥ 4 points.

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Acknowledgements

The authors would like to all staff members working to collect the many samples. We also extend thanks to Tomomi Oe for the supervisor.

Funding

This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan

    Kenichi Oe, Hirokazu Iida, Yosuke Otsuki, Takashi Toyoda, Fumito Kobayashi, Shohei Sogawa, Tomohisa Nakamura & Takanori Saito

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  1. Kenichi Oe
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Contributions

KO designed the study. YO, TT, FK, and SS collected and performed the analysis of the data. KO wrote the manuscript. HI, TN, and TS supervised the study. All authors gave their final approval of the version to be published.

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Correspondence to Kenichi Oe.

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This study was approved by the Ethical Committee of the Kansai Medical University (H120167).

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Oe, K., Iida, H., Otsuki, Y. et al. Validity of a preoperative scoring system for surgical management of periprosthetic hip infection: one-stage vs. two-stage revision. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05279-5

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