Transfer of Patient Care During Two-Stage Exchange for Periprosthetic Joint Infection Leads to Inferior Outcomes

摘要

Postoperative infections involving total hip arthroplasty (THA) and total knee arthroplasty (TKA) are devastating complications. Not only are these infections challenging for the surgeon, but there are also significantly increased healthcare costs, as well as dramatic physical and emotional burdens that the patient must endure [1-4]. Despite improvements in the operating room environment and in operative techniques [5-7], infection continues to be a major cause of failure after total hip and knee arthroplasty [2,7-10].The current gold standard for treating chronic periprosthetic joint infections (PJI) is a two-stage approach. In this approach, all foreign materials including implants, bone cement, and necrotic tissue are removed with or without an antibiotic cement spacer at the first stage. A long course of intravenous antibiotics is then initiated with a goal of eventual joint reconstruction with new implants at the second stage [11-14]. The success rate of a two-stage revision procedure can range from 67% to 100% [14-23]. The wide range of success rates of two-stage revision may be attributable to various factors. Inferior results in more difficult cases may be due to the patient's general medical condition, antibiotic resistance of causative microorganisms, culture-negative infections, and those with increased surgical times during reimplantation [20,24-26].