Voltar
Artigo Acesso aberto Produção Nacional Revisado por pares
BIBTEX RIS

Timing of implant-removal in late acute periprosthetic joint infection: A multicenter observational study

2019; Elsevier BV; Volume: 79; Issue: 3 Linguagem: Inglês

10.1016/j.jinf.2019.07.003

ISSN

1532-2742

Autores

Marjan Wouthuyzen‐Bakker, Marine Sebillotte, José Manuel Lomas, Benjamin Kendrick, Eva Benavent, Óscar Murillo, Javad Parvizi, Noam Shohat, Javier Cobo Reinoso, Rosa Escudero Sánchez, Marta Fernández-Sampedro, Éric Senneville, Kaisa Huotari, José María Barbero Allende, Antonio Blanco García, Jaime Lora-Tamayo, Matteo Carlo Ferrari, Danguolė Važnaisienė, Erlangga Yusuf, Craig Aboltins, Rihard Trebše, Mauro José Costa Salles, Natividad Benito, Andrea Vila, María Dolores del Toro, Tobias Siegfried Kramer, Sabine Petersdorf, Vicens Díaz-Brito, Zeliha Koçak Tufan, Marisa Sánchez, C. Arvieux, Álex Soriano,

Tópico(s)

Total Knee Arthroplasty Outcomes

Resumo

Objectives We evaluated the treatment outcome in late acute (LA) periprosthetic joint infections (PJI) treated with debridement and implant retention (DAIR) versus implant removal. Methods In a large multicenter study, LA PJIs of the hip and knee were retrospectively evaluated. Failure was defined as: PJI related death, prosthesis removal or the need for suppressive antibiotic therapy. LA PJI was defined as acute symptoms <3 weeks in patients more than 3 months after the index surgery and with a history of normal joint function. Results 445 patients were included, comprising 340 cases treated with DAIR and 105 cases treated with implant removal (19% one-stage revision (n = 20), 74.3% two-stage revision (n = 78) and 6.7% definitive implant removal (n = 7). Overall failure in patients treated with DAIR was 45.0% (153/340) compared to 24.8% (26/105) for implant removal (p < 0.001). Difference in failure rate remained after 1:1 propensity-score matching. A preoperative CRIME80-score ≥3 (OR 2.9), PJI caused by S. aureus (OR 1.8) and implant retention (OR 3.1) were independent predictors for failure in the multivariate analysis. Conclusion DAIR is a viable surgical treatment for most patients with LA PJI, but implant removal should be considered in a subset of patients, especially in those with a CRIME80-score ≥3.

Referência(s)