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Successful eradication rate following one-stage septic knee and hip exchange in selected pre-operative culture-negative periprosthetic joint infections

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Abstract

Purpose

The main requirement for performing the one-stage septic exchange is the pre-operative identification of the pathogen and its susceptibility. The purpose of this study is to evaluate the success rate with special focus on reinfection in a cohort of patients who underwent one-stage septic knee or hip revision for pre-operative culture-negative PJI.

Methods

We retrospectively analyzed 640 patients treated by one-stage revision for chronic knee or hip PJI between January 1, 2016, and December 31, 2018. Only cases with pre-operative culture-negative PJI, with culture-negative synovial aspirations and one negative open biopsy, were analyzed. We evaluated the septic and aseptic complication and the rate of complication-free survival defined as the time from the date of first operation and the date of complication events.

Results

A total of 22 patients fulfilled the inclusion and were enrolled. The mean age of the group was 73.2 ± 9.8 years, with a median ASA score of 3 (range 3–4). After mean follow-up of 3.6 ± 2.6 years, 86.4% (19 out of 22) of patients reported no complications. Two patients (9.1%) after one-stage hip required revision arthroplasty due to septic failure, while one patient (4.5%) with one-stage knee had revision for femoral component aseptic loosening.

Conclusion

Our analysis suggests that the absence of pre-operative pathogen detection may not be contraindication to the one-stage revision in selected patients. The one-stage exchange might be considered in patients with pre-operative negative cultures in presence of ASA > 3 and multiple comorbidities that are not able to tolerate multiple surgeries.

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Data availability

Data and materials are available.

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Author notes

  1. Luigi Zanna and Rudy Sangaletti contributed equally in writing this article.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany

    Luigi Zanna, Rudy Sangaletti, Christian Lausmann, Thorsten Gehrke & Mustafa Citak

  2. Department of Orthopaedic Surgery, University Hospital of Florence, Aou Careggi, Florence, Italy

    Luigi Zanna

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Contributions

LZ and RS contributed to the conception and design of the work, data analysis, drafting of the paper, and revising it critically for important intellectual content study. LZ, RS, and CL contributed to the data analysis and drafting of the paper. MC and TG contributed to the conception and design of the work and revised the paper critically for important intellectual content study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mustafa Citak.

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Ethical approval was performed and has the following number: 2022–300240-WF.

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Conflict of interest

M.C. has received funding from W. Link & Co KG outside the submitted work.

T.G. has received funding from W. Link & Co KG, Zimmer Biomet Inc., Heraeus and from Ceramtec Co. outside the submitted work.

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Zanna, L., Sangaletti, R., Lausmann, C. et al. Successful eradication rate following one-stage septic knee and hip exchange in selected pre-operative culture-negative periprosthetic joint infections. International Orthopaedics (SICOT) 47, 659–666 (2023). https://doi.org/10.1007/s00264-022-05677-7

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