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Spacer exchange in persistent periprosthetic joint infection: microbiological evaluation and survivorship analysis

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

Abstract

Purpose

The purposes of this study were to determine demographics and characteristics of patients who underwent spacer exchange for persistent infection in the setting of two-stage arthroplasty for periprosthetic joint infection, to describe the microbiology of pathogens involved, to analyze survivorship free from infection in these patients.

Methods

The institutional prospectively collected database was reviewed to enroll patients with minimum 2 years follow-up. Patients who underwent two-stage procedure for septic arthritis were excluded, as were patients who had spacer fracture or dislocation.

Results

A total of 34 patients (41 procedures) were included. Mean age was 65.0 ± 12.8 years. Mean follow-up was 53.4 ± 24.8 months. Mean number of previous procedures was 3.6 ± 1.2. A total of 27 (79.4%) patients underwent final reimplantation. The most frequently isolated pathogen in spacer exchange was Staphylococcus epidermidis (10 cases, 28.6%). Polymicrobial cultures were obtained from 9 (25.71%) patients, 10 (28.6%) presented culture-negative infections. A total of 11 (32.4%) resistant pathogens were isolated, and 16 (47.0%) difficult to treat pathogens were detected. Eradication rate was 78.8%. Overall survivorship of implants after final reimplantation was 72.8% at 51.8 months.

Conclusion

Surgeons should be aware that subjects necessitating spacer exchange often present multiple comorbidities, previous staged revision failures, soft-tissue impairment and difficult to treat infection. In these patients, spacer exchange provides good clinical results and infection eradication, preventing arthrodesis or amputation.

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Funding

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

Author information

Authors and Affiliations

  1. Department of Orthopedics and Traumatology, C.T.O. Hospital, via G. Zuretti 29, 10126, Turin, Italy

    Antonio Clemente & Alessandro Massè

  2. Department of Surgical Science (DSC) University of Turin, C.so Dogliotti 14, 10126, Turin, Italy

    Antonio Clemente & Alessandro Massè

  3. Joint Arthroplasty Unit, Orthopedic and Traumatology 2, Santa Corona Hospital, Viale XXV Aprile 38, Pietra Ligure, Italy

    Luca Cavagnaro & Francesco Chiarlone

  4. Orthopaedic Clinic, San Martino Hospital, Largo R. Benzi 10, 16132, Genoa, Italy

    Antonio Russo

  5. University of Genoa, Genoa, Italy

    Antonio Russo

  6. Prosthetic Surgery Centre, Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy

    Giorgio Burastero

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  1. Antonio Clemente
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  2. Luca Cavagnaro
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  4. Francesco Chiarlone
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AC, LC, AR and FC. The first draft of the manuscript was written by AC and all authors commented on previous versions of the manuscript. Entire research study was supervised by GB and AM. All authors read and approved the final manuscript.

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Correspondence to Antonio Clemente.

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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.

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Ethics approval was obtained by local institutional review board.

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Informed consent, publish consent and privacy and data consent were obteined from all the participant to the study.

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Clemente, A., Cavagnaro, L., Russo, A. et al. Spacer exchange in persistent periprosthetic joint infection: microbiological evaluation and survivorship analysis. Arch Orthop Trauma Surg 143, 1361–1370 (2023). https://doi.org/10.1007/s00402-021-04300-5

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  • DOI: https://doi.org/10.1007/s00402-021-04300-5

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