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Characteristics and treatment outcomes of 69 cases with early prosthetic joint infections of the hip and knee

  • Clinical and Epidemiological Study
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Abstract

Purpose

Early prosthetic joint infection (PJI) can be treated with an intensive surgical debridement and implant retention (DAIR) of the prosthesis if (1) the prosthesis is stable, (2) the pathogen is not a difficult-to-treat microorganism, (3) symptoms have lasted for <3 weeks and (4) a sinus tract is absent.

Methods

We retrospectively evaluated the treatment outcome of early PJI in the hip and knee in a single orthopaedic centre. An early PJI was defined as a prosthesis infection within 3 months after primary implantation or revision surgery for a non-infectious cause.

Results

We identified 69 patients with confirmed early PJI, with a median age of 71 (range 33–84) years. Only 64 % presented with ≥2 acute signs of infection. The most commonly isolated bacteria were coagulase-negative staphylococci (38 %) and Staphylococcus aureus (25 %). Surgical procedures included DAIR (50 cases, 69 %) and two-stage exchange (19 cases, 31 %). At last follow-up, five of remaining living 67 patients (7.5 %) had a relapse of infection. The overall relapse-free survival of the prosthesis after 2 years was 92.3 % (95 % confidence interval 82–97 %) with no significant difference between DAIR and exchange of prosthesis.

Conclusion

Our data suggest that an early PJI should be treated with DAIR as a less invasive procedure whenever possible according to the established treatment algorithm.

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Acknowledgments

We thank Werner Zimmerli, M.D. for providing useful comments. This study was supported by a grant of the Hans-Paul Wälchli Foundation for Research (Lugano, Switzerland) and a fellowship grant supported by the Swiss National Science Foundation (Switzerland, PBZHP3_141483).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Microbial Pathogenesis, Dental School, University of Maryland, 650 W. Baltimore Street, Baltimore, MD, 21201, USA

    Y. Achermann

  2. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, 8091, Zurich, Switzerland

    Y. Achermann

  3. Infectious Diseases Service, Department of Internal Medicine, Cantonal Hospital Zug, 6340, Baar, Switzerland

    P. Stasch & M. Vogt

  4. Schulthess Clinic, 8008, Zurich, Switzerland

    S. Preiss & M. Vogt

  5. Microbiology Laboratory, Unilabs, 8008, Zurich, Switzerland

    K. Lucke

Authors
  1. Y. Achermann
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  2. P. Stasch
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  3. S. Preiss
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  4. K. Lucke
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  5. M. Vogt
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Corresponding author

Correspondence to Y. Achermann.

Additional information

Y. Achermann and P. Stasch both contributed equally to this work.

After completion of the study, Y. Achermann relocated to the research laboratory of Mark E. Shirtliff, University of Maryland, Baltimore, USA.

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Achermann, Y., Stasch, P., Preiss, S. et al. Characteristics and treatment outcomes of 69 cases with early prosthetic joint infections of the hip and knee. Infection 42, 511–519 (2014). https://doi.org/10.1007/s15010-014-0584-6

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  • DOI: https://doi.org/10.1007/s15010-014-0584-6

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