Methods: We retrospectively reviewed patients with PJI who had revision surgery between January 1, 2000 and December 31, 2010 at SHSC/ HOAC. PJI were identified using the Ontario Joint Replacement Record System. Infection was defined by gross intraoperative evidence, positive intraoperative culture, and/or sinus tract prior to operation. The primary outcome was treatment failure at one year after revision surgery based on further surgery, ongoing infection and/or continuous suppressive antibiotics.
Results: Of the 139 patients with PJI, 85 (61%) involved knees and 50 (36%) hips. For the initial procedure, 29 (21%) underwent I&D, 35 (25%) one-stage, and 75 (54%) two-stage revisions. Of 81 (58%) culture positive cases, CNST (47;34%) and Staph. aureus (18;13%) were the most common pathogens The overall treatment success rate was 78% (95% CI: 70-84). There was no difference in outcome between one-stage (94%; 95% CI: 81-98) and two-stage revisions (84%; 95% CI: 74-91). Only 41% (95%; CI: 26-59) of I&D procedures were successful. Multivariate logistic regression analysis revealed I&D associated with high failure rates (odds ratio = 102.4; 95% CI: 8.6-1225.3), with a trend towards lower failure rates with one versus two-stage revision (odds ratio = 0.028, 95% CI: 0.001-1.500). Other predictors of treatment failure included history of prior revisions, and infection with Peptostreptococcus spp. Among two-stage revisions, we did not detect a significant reduction in treatment failure associated with antibiotic-free period prior to the second procedure (OR 2.6, 95%CI 0.23-29.8).
Conclusion: Our findings question the value of customary approaches to prosthetic joint infection management such as the use of two stage procedures and antibiotic-free periods prior to definitive revision. Randomized controlled trials are needed to inform best practice for treatment of these complex infections.
S. Mubareka, None
R. Jenkinson, None
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