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Within 1 year of spacer placement and removal of infected hip implant, 16% of patients retained spacers
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Results from this study demonstrated that at 1 year after removal of a total hip arthroplasty implant followed by placement of a cement spacer for periprosthetic joint infection, 16.8% of patients retained their spacers and 10.8% needed repeat debridement.
“[After] analyzing a national sample, only 60% of patients undergo reimplantation at 1 year following explantation and spacer placement for deep infection following total hip arthroplasty, suggesting that previous reports focusing on staged revision may overestimate the success of the procedure and neglect a not insignificant population of patients with retained spacers,” Jourdan M. Cancienne, MD, from the department of orthopedic surgery at the University of Virginia School of Medicine, told Healio.com/Orthopedics.
Using a national database, Cancienne and colleagues identified 7,146 Medicare patients who underwent removal of an infected hip prothesis and had placement of an antibiotic spacer. Multivariate logistic regression analysis was used to evaluate independent patient-related risk factors for in-hospital mortality, repeat debridement without reimplantation within 1 year, resection arthroplasty and reimplantation of a hip arthroplasty.
Results after 1-year postoperatively showed 464 patients died in a hospital setting, 775 patients had a repeat debridement, 404 patients had resection arthroplasty, 1,202 patients retained their spacers and 4,301 patients underwent reimplantation at an average of 124.4 days.
Risk factors for death included male gender, age older than 85 years, diabetes, congestive heart failure, chronic lung disease, liver disease and hemodialysis. Risk factors for repeat debridement, but not reimplantation, included obesity, inflammatory arthritis, depression, hyperlipidemia, chronic kidney disease and chronic liver disease. Female gender, age older than 85 years, diabetes, peripheral vascular disease, congestive heart failure, hemodialysis and depression were among the predictors for no reimplantation within 1 year. – by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Wael K. Barsoum, MD
Any surgeon who performs THA laments the day they hear about a patient returning to the clinic or to the emergency department with the signs and symptoms consistent with an infected THA. For most of us, this means the patient will likely require, at best, an irrigation and debridement, but more likely a two-stage revision. Many orthopedic surgeons today continue to quote data that are outdated when it comes to the outcomes associated with infected THAs. Sadly, we tend to be overly optimistic. This study does an excellent job of clearly showing that the morbidity, failure rate and overall complications associated with this diagnosis are far greater than many perceive.
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