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Study on two-stage exchange for PJI shows reimplantation not required in some cases
Recently published data indicated most patients who underwent the first-stage procedure of the two-stage resection arthroplasty for the treatment of periprosthetic joint infection did not require consecutive reimplantation or another spacer exchange in the interim.
“[This] study highlights the fact that the commonly held belief that two-stage exchange arthroplasty carries a high success rate for eradication of periprosthetic joint infection may need to be re-examined,” the authors wrote. “ A considerable number of patients undergoing resection arthroplasty and spacer insertion do not undergo subsequent reimplantation for a variety of reasons, and many are subjected to interim surgical procedures.”
Researchers used the joint arthroplasty database to identify 482 patients (326 knee and178 hip procedures) treated for periprosthetic joint infections (PJI) with resection arthroplasty and a spacer inserted as part of a two-stage arthroplasty procedure. Researchers also retrospectively performed a chart review to obtain data which included: surgical procedure details, spacer type used, microbiological data and patients’ clinical course after resection arthroplasty and placement of spacer.
There were 417 cases of reimplantation. No difference was observed between spacer types for reimplantation rate or success rate of the procedure. There were 329 joints with a minimum 1-year follow-up, with 81.4% treated successfully. There were 87 cases that did not require a second-stage reimplantation. Of these, six cases needed an amputation, five cases were treated with a Girdlestone procedure, four cases had an arthrodesis and 72 cases retained spacers.
The overall mortality rate at 30 days was 1.2%, at 90 days it was 2.6%, 6.5% at 1 year and 10.3% at 2 years. No difference was observed in the reimplantation rate in 76 patients with PJI due to a resistant organism, even though the amount of interim spacer exchanges had significantly increased. High BMI was correlated with a significantly higher total amount of procedures, according to researchers.‒ by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.