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Description of surgical treatment methods of hip and knee periprosthetic joint infections in the Chinese mainland: a national multi-centre survey

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Abstract 

Purpose

Periprosthetic joint infection (PJI) is a serious hip and knee arthroplasty complication. Despite the increased incidence of primary joint replacements, there is no clear guideline for treating PJI in the Chinese mainland yet. We aim to measure the current situation and basis for surgical treatment methods of PJI in major orthopaedic hospitals in the Chinese mainland.

Methods

We conducted a national survey on PJI treatment in Mainland China. Forty-one top arthroplasty centers were included, with 82.9% (34/41) response rate. The data were analyzed using Microsoft Excel version 20.0 and described as numbers and percentages.

Results

For acute infections, prosthesis-preserving procedures (DAIR) are used in all centres. For hip and knee PJI, 20.5% (7/34) and 35% (12/34) of the centres used a one-stage exchange. If applied, this treatment will necessitate the previous patients’ selection for a satisfactory outcome. All centres execute the two-stage exchange. Between phases, the majority of centres implant a cemented spacer. Revisions for infected hips included 21 (4.3%) cases of DAIR, 95 (19.9%) cases of single-stage exchange, 362 (75.2%) cases of two-stage exchange, and 2 (0.007%) cases of hip dissection. Revisions for infected knee comprised 88 (19.0%) cases of DAIR, 48 (10.3%) cases of single-stage exchange, 324 (69.8%) cases of two-stage exchange, and 5 (0.02%) cases of knee fusion.

Conclusions

The centers do not have a uniform PJI standard. Most patients have two-stage revision with a cemented spacer in China. These concepts can help establish treatment guidelines.

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Data availability

The datasets used or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

PJI:

Periprosthetic joint infection

THA:

Total hip arthroplasty

TKA:

Total knee arthroplasty

PMMA:

Polymethylmethacrylat

DAIR:

Debridement, antibiotics, irrigation, and retention of the prosthesis

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Acknowledgements

We thank The Chinese Hip/Knee PJI investigation Group: Weiming Liao MD, Wenming Zhang MD, Qin Jiang, Liaobing Chen MD, Jun Xiao MD, Weihua Xu MD, Rui He MD, Yongqing XU MD, Jianlin Zuo MD, Yihe Hu MD, Wanchun Wang MD, Tang Liu MD, Wei Huang MD, Shuqing Tao MD, Qirong Qian MD, Yingzhen Wang MD, Tao Li , Xiaobin Tian MD, Wenbo Wang MD, Qunhua JIN MD, Hong Yuan MD, Xifu Shang MD, Zhanjun Shi MD, Jia Zheng MD, and Jianzhong Xu MD.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China

    Huiming Peng

  2. Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China

    Zongke Zhou

  3. Department of Adult Joint Reconstruction, Xi’an Honghui Hospital, Xi’an 710054, China

    Peng Xu

  4. Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China

    Fei Wang

  5. Department of Orthopedic Surgery, Xijing Hospital of Air Force Medical University, Xi’an, 710032, China

    Qinsheng Zhu

  6. Department of Orthopedic Surgery, Lanzhou University Second Hospital, Lanzhou, 730030, China

    Yayi Xia

  7. Department of Orthopedics, The Second Hospital of Jilin University, Changchun, 130021, China

    Jincheng Wang

  8. Department of Orthopedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310015, China

    Shigui Yan

  9. Department of Orthopedic Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China

    Li Cao

  10. Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China

    Xisheng Weng

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  1. Huiming Peng
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  3. Peng Xu
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The Chinese Hip/Knee P. J. I. Investigation Group

Contributions

HMP and XSW were responsible for data collection, analysis, and interpretation of data, design of the work, and revision. HMP and XSW were responsible for data collection and revision. All the authors approved the submitted version and agreed to be personally accountable for the author’s contributions and ensured that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, were appropriately investigated, resolved, and the resolution documented in the literature. All the authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Xisheng Weng.

Ethics declarations

Ethics approval and consent to participate

The national multi-center survey was approved by the local institutional ethical committee of the Chinese Academy of Medical Science and Peking Union Medical College (protocol number: S-K993). Due to the survey character of the study, without patient data or intervention, consent was not necessary.

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Not applicable.

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The authors declare no competing interests.

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Peng, H., Zhou, Z., Xu, P. et al. Description of surgical treatment methods of hip and knee periprosthetic joint infections in the Chinese mainland: a national multi-centre survey. International Orthopaedics (SICOT) 47, 1423–1431 (2023). https://doi.org/10.1007/s00264-023-05796-9

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