Nonmodifiable factors predict treatment success for periprosthetic joint infections
Click Here to Manage Email Alerts
Predictors of treatment success in periprosthetic joint infections include nonmodifiable factors like the joint where the infection occurred, age of the implant, patient age and comorbidities, and what caused the infection, a study found.
The results of the study, which was conducted at nearly 30 hospitals in Australia and New Zealand, “suggests that debridement and implant retention should be reserved for early post-implant infections, and that matching a patient to the appropriate management strategy is the key role of treating clinicians,” the researchers wrote.
“I am an infectious diseases physician, and a big part of my practice is seeing patients with prosthetic joint infection (PJI),” Joshua S. Davis, MBBS, PhD, DTM&H, staff specialist in infectious diseases and general medicine at the John Hunter Hospital in Australia, told Healio. “This is a frustrating condition to treat, as the evidence base informing its management is very poor.”
“What we really need are randomized controlled trials addressing common management questions — for example, what is the best type and duration of antibiotic therapy? What is the best surgical strategy?” Davis said. “However, before we could do that, we wanted to create a network of collaborating sites and investigators, and measure current practice variation and outcomes.”
David and colleagues began the PIANO study, which prospectively enrolled and collected data on 783 patients with PJI at 27 hospitals in Australia and New Zealand between July 2014 and December 2017 making it the largest study of its kind globally.
The collected data at baseline and at 3, 12 and 24 months. The main outcome measures at 24 months were clinical cure and treatment success.
Overall, 24-month outcome data were available for 653 patients in December 2019, of whom 449 (69%) experienced clinical cure and 350 (54%) had treatment success. Davis and colleagues found that the most common treatment strategy was debridement and implant retention, with success rates being the highest among early post-implant infections (74%) and lower in the late acute and chronic infections (49% and 44%, respectively).
The study also demonstrated that selected variables, such as knee joints — compared with hip joints, for example — and Staphylococcus aureus infection, were independently associated with treatment failure. However, antibiotic choice and duration and the extent of debridement were not.
“The choice of the appropriate surgical strategy — debridement with implant retention, revision or other — is the key determinant of a good outcome, much more so than the type or duration of antibiotic therapy,” Davis said. “Both orthopedic surgeons and infectious diseases physicians should be involved in discussions with the patient to choose the best treatment approach in their specific case.”
Collapse
Read more about
Click Here to Manage Email Alerts