Background: Persistent infection rate after 2-stage reimplantation complicating elbow arthroplasty has been reported to be as high as 25%. The purposes of this retrospective study were to determine the infection eradication rates, complications and outcomes in a cohort of patients treated with two-stage reimplantation for deep periprosthetic joint infection (PJI) following total elbow arthroplasty (TEA) and to determine possible associated risk factors for treatment failure.
Methods: Between 2000 and 2017, 52 elbows underwent a two-stage reimplantation for PJI after TEA. There were 22 males and 30 females with a mean age of 61 (range, 25-82) years. The most common bacterium was (28 elbows). Mayo Elbow Performance Scores were calculated at the latest follow-up. Mean follow-up time was 6 years (range, 2-14 years).
Results: PJI was eradicated in 36 elbows (69%). The remaining 16 elbows were considered treatment failures secondary to recurrent infection. The risk of persistent infection was 3.3 times higher in elbows with retained cement (p 0.04), and 3.5 times higher when the infecting organism was (p 0.06).
Conclusion: Two-stage reimplantation for PJI after TEA was successful in eradicating deep infection in 69% of cases. The eradication of PJI after TEA still needs to be improved substantially.
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http://dx.doi.org/10.1177/17585732211043524 | DOI Listing |
Cureus
December 2024
Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, JPN.
Background: Two-stage revision is known as the gold-standard method for knee prosthetic joint infection (PJI), but the most suitable treatment method remains controversial. Typically, weight-bearing is restricted during the interval between the stages. The aim of this study was to evaluate the clinical outcomes of unrestricted weight bearing with cement spacers fabricated using the Knee Articulating Spacer Mold (KASM®; Ortho Development Corporation, Draper, UT, USA) for knee PJI.
View Article and Find Full Text PDFJBJS Essent Surg Tech
January 2025
Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, Florida.
Background: The incidence of revision shoulder arthroplasty continues to rise, and infection is a common indication for revision surgery. Treatment of periprosthetic joint infection (PJI) in the shoulder remains a controversial topic, with the literature reporting varying methodologies, including the use of debridement and implant retention, single-stage and 2-stage surgeries, antibiotic spacers, and resection arthroplasty. Single-stage revision has been shown to have a low rate of recurrent infection, making it more favorable because it precludes the morbidity of a 2-stage operation.
View Article and Find Full Text PDFBone Joint J
January 2025
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Arch Orthop Trauma Surg
December 2024
Department of Orthopedic Surgery and Orthopedic Research Institute, Stem Cell and Tissue Engineering Research Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
Purpose: The two-stage exchange revision represents a pivotal strategy in the management of prosthetic joint infections, wherein the judicious timing of reimplantation serves as a crucial determinant for therapeutic success. At present, attempts have been made to utilize predictive models to establish the optimal timing for reimplantation; however, their predictive accuracy remains unsatisfactory. This inadequacy primarily arises from the lack of dependable predictive indicators, which demonstrate inconsistent effectiveness across various studies and occasionally yield contradictory outcomes.
View Article and Find Full Text PDFOrthop Traumatol Surg Res
November 2024
Service de Chirurgie Orthopédique et Médecine du Sport, Centre d'Excellence FIFA, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622 Villeurbanne, France.
In two-stage revision of infected implants, the first stage involves removing the implant and implanting a joint spacer, and the second stage involves implanting a new prosthesis at least 6 weeks later. Spacers have two main functions: local administration of high-dose antibiotics, and preservation of the joint space by reducing soft tissue retraction and improving patient comfort until reimplantation. The present review aims to detail the necessary characteristics of antibiotics added to cement to achieve good joint diffusion, to describe the steps of two-stage revision, and to present the types of spacer available according to the joint and complications.
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