Risk factors for mortality following one-stage septic hip arthroplasty - a case-control study.
Aseptic
Mortality
One-stage septic exchange
Periprosthetic joint infection
Risk factors
Septic
Total hip arthroplasty
Journal
International orthopaedics
ISSN: 1432-5195
Titre abrégé: Int Orthop
Pays: Germany
ID NLM: 7705431
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
12
08
2021
accepted:
22
09
2021
pubmed:
1
10
2021
medline:
11
3
2022
entrez:
30
9
2021
Statut:
ppublish
Résumé
Despite good clinical outcomes and a high success rate, there is a comparatively high mortality after one stage septic exchange of total hip arthroplasty. The aim of this study was to identify risk factors for mortality in the hospitalization period after one-stage septic exchange of THA. We retrospectively analyzed in our database all patients who had a one-stage septic exchange for periprosthetic infection of THA and died during hospitalization (n = 33). The control group was matched semi-randomly by surgical procedure (n = 121) who did not die during hospitalization. The two groups were analyzed for risk factors such as age, Charlson Comorbidity Index (CCI), and high-/low-virulence bacteria. In the deceased group, 16 patients were female and 17 were male with a mean age at surgery of 73.2 years. In the control group, there were 55 females and 66 males with an average age at surgery of 68.2 years. Comparing the two groups, the deceased group had a significantly higher proportion of liver disease as well as higher rate of pulmonary embolism, apoplexy, and/or myocardial infarction, an increased CCI with an average of 6.5 and advanced age. Further demographic and surgery-related parameters especially high- or low-virulent germs were not identified as risk factors for mortality during the hospitalization period. The binominal logistic regression analysis showed that the probability of an inpatient death following one-stage septic exchange of THA increases by a factor of 3.079, with each additional point of the CCI. In conclusion, advanced age and high CCI are the main risk factors for mortality after single-stage septic change of THA. However, high-virulence bacteria have no influence on the mortality during the hospitalization period after one-stage septic exchange of THA.
Identifiants
pubmed: 34591156
doi: 10.1007/s00264-021-05230-y
pii: 10.1007/s00264-021-05230-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
507-513Informations de copyright
© 2021. The Author(s) under exclusive licence to SICOT aisbl.
Références
Brochin RL, Phan K, Poeran J, Zubizarreta N, Galatz LM, Moucha CS (2018) Trends in periprosthetic hip infection and associated costs: a population-based study assessing the impact of hospital factors using national data. J Arthroplasty 33:S233–S238. https://doi.org/10.1016/j.arth.2018.02.062
doi: 10.1016/j.arth.2018.02.062
pubmed: 29573912
Schutzer SF, Harris WH (1988) Deep-wound infection after total hip replacement under contemporary aseptic conditions. J Bone Joint Surg Am 70:724–727
doi: 10.2106/00004623-198870050-00013
García S, Soriano Á, Esteban P, Almela M, Gallart X, Mensa J (2005) Utilidad de la adición de antibiótico al cemento en el recambio en 1 tiempo en la infección crónica de una prótesis total de cadera. Med Clin 125:138–139. https://doi.org/10.1157/13076942
doi: 10.1157/13076942
Ahmed SS, Begum F, Kayani B, Haddad FS (2019) Risk factors, diagnosis and management of prosthetic joint infection after total hip arthroplasty. Expert Rev Med Devices 16:1063–1070. https://doi.org/10.1080/17434440.2019.1696673
doi: 10.1080/17434440.2019.1696673
pubmed: 31752561
Bozic KJ, Kamath AF, Ong K, Lau E, Kurtz S, Chan V, Vail TP, Rubash H, Berry DJ (2015) Comparative epidemiology of revision arthroplasty: failed THA poses greater clinical and economic burdens than failed TKA. Clin Orthop Relat Res 473:2131–2138. https://doi.org/10.1007/s11999-014-4078-8
doi: 10.1007/s11999-014-4078-8
pubmed: 25467789
Reina N, Delaunay C, Chiron P, Ramdane N, Hamadouche M (2013) Infection as a cause of primary total hip arthroplasty revision and its predictive factors. Orthop Traumatol Surg Res 99:555–561. https://doi.org/10.1016/j.otsr.2013.07.001
doi: 10.1016/j.otsr.2013.07.001
pubmed: 23891660
Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351:1645–1654. https://doi.org/10.1056/NEJMra040181
doi: 10.1056/NEJMra040181
pubmed: 15483283
Moore AJ, Blom AW, Whitehouse MR, Gooberman-Hill R (2017) Managing uncertainty - a qualitative study of surgeons’ decision-making for one-stage and two-stage revision surgery for prosthetic hip joint infection. BMC Musculoskelet Disord 18:154. https://doi.org/10.1186/s12891-017-1499-z
doi: 10.1186/s12891-017-1499-z
pubmed: 28403859
pmcid: 5388991
Bori G, Muñoz-Mahamud E, Cuñé J, Gallart X, Fuster D, Soriano A (2014) One-Stage Revision Arthroplasty Using Cementless Stem for Infected Hip Arthroplasties. J Arthroplasty 29:1076–1081. https://doi.org/10.1016/j.arth.2013.11.005
doi: 10.1016/j.arth.2013.11.005
pubmed: 24332970
Choi H-R, Kwon Y-M, Freiberg AA, Malchau H (2013) Comparison of One-stage revision with antibiotic cement versus two-stage revision results for infected total hip arthroplasty. J Arthroplasty 28:66–70. https://doi.org/10.1016/j.arth.2013.02.037
doi: 10.1016/j.arth.2013.02.037
pubmed: 23972299
Buchholz HW, Elson RA, Engelbrecht E, Lodenkamper H, Rottger J, Siegel A (1981) Management of deep infection of total hip replacement. J Bone Joint Surg Br 63-B:342–353
Gehrke T, Zahar A, Kendoff D (2013) One-stage exchange: it all began here. Bone Joint J 95-B:77–83. https://doi.org/10.1302/0301-620X.95B11.32646
Negus JJ, Gifford PB, Haddad FS (2017) Single-stage revision arthroplasty for infection—an underutilized treatment strategy. J Arthroplasty 32:2051–2055. https://doi.org/10.1016/j.arth.2017.02.059
doi: 10.1016/j.arth.2017.02.059
pubmed: 28390887
Klouche S, Leonard P, Zeller V, Lhotellier L, Graff W, Leclerc P, Mamoudy P, Sariali E (2012) Infected total hip arthroplasty revision: One- or two-stage procedure? Orthop Traumatol Surg Res 98:144–150. https://doi.org/10.1016/j.otsr.2011.08.018
doi: 10.1016/j.otsr.2011.08.018
pubmed: 22364829
Leonard HA, Liddle AD, Burke O, Murray DW, Pandit H (2014) Single- or two-stage revision for infected total hip arthroplasty? A systematic review of the literature. Clin Orthop Relat Res 472:1036–1042. https://doi.org/10.1007/s11999-013-3294-y
doi: 10.1007/s11999-013-3294-y
pubmed: 24057192
Babst R, Jenny H, Morscher E (1989) Treatment of infected hip joint arthroplasty. Results of treatment of 62 infected total prosthesis arthroplasties. Orthopade 18:517–526
pubmed: 2608271
Hischebeth GT, Randau TM, Ploeger MM, Friedrich MJ, Kaup E, Jacobs C, Molitor E, Hoerauf A, Gravius S, Wimmer MD (2019) Staphylococcus aureus versus Staphylococcus epidermidis in periprosthetic joint infection—outcome analysis of methicillin-resistant versus methicillin-susceptible strains. Diagn Microbiol Infect Dis 93:125–130. https://doi.org/10.1016/j.diagmicrobio.2018.08.012
doi: 10.1016/j.diagmicrobio.2018.08.012
pubmed: 30266398
Peng HM, Wang LC, Chen JY, Zhou YX, Tian H, Lin JH, Guo WS, Lin Y, Qu TB, Guo A, Cao YP, Weng XS (2019) Microbiology analysis of periprothetic joint infection post total hip and knee arthroplasty of 9 centers in Beijing between 2014 and 2016. Zhonghua Wai Ke Za Zhi 57:596–600. https://doi.org/10.3760/cma.j.issn.0529-5815.2019.08.007
doi: 10.3760/cma.j.issn.0529-5815.2019.08.007
pubmed: 31422629
Izakovicova P, Borens O, Trampuz A (2019) Periprosthetic joint infection: current concepts and outlook. EFORT Open Rev 4:482–494. https://doi.org/10.1302/2058-5241.4.180092
doi: 10.1302/2058-5241.4.180092
pubmed: 31423332
pmcid: 6667982
Senthi S, Munro JT, Pitto RP (2011) Infection in total hip replacement: meta-analysis. Int Orthop 35:253–260. https://doi.org/10.1007/s00264-010-1144-z
doi: 10.1007/s00264-010-1144-z
pubmed: 21085957
Gross CE, Della Valle CJ, Rex JC, Traven SA, Durante EC (2020) Fungal periprosthetic joint infection: a review of demographics and management. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.11.005
Rosteius T, Jansen O, Fehmer T, Baecker H, Citak M, Schildhauer TA, Gessmann J (2018) Evaluating the microbial pattern of periprosthetic joint infections of the hip and knee. J Med Microbiol 67:1608–1613. https://doi.org/10.1099/jmm.0.000835
doi: 10.1099/jmm.0.000835
pubmed: 30207518
Hartzler MA, Li K, Geary MB, Odum SM, Springer BD (2020) Complications in the treatment of prosthetic joint infection. Bone Joint J 102-B:145–150. https://doi.org/10.1302/0301-620X.102B6.BJJ-2019-1582.R1
Negus JJ, Gifford PB, Haddad FS (2017) Single-stage revision arthroplasty for infection-an underutilized treatment strategy. J Arthroplasty 32:2051–2055. https://doi.org/10.1016/j.arth.2017.02.059
doi: 10.1016/j.arth.2017.02.059
pubmed: 28390887
Thiesen DM, Sobhani H, Gehrke T, Suero EM, Klatte TO, Citak M (2020) A comparison of short term complication rate between 44 two- and 385 one-stage septic exchange arthroplasties in chronic periprosthetic joint infections. Orthop Traumatol Surg Res:102668. https://doi.org/10.1016/j.otsr.2020.05.008
Unter Ecker N, Suero EM, Gehrke T, Haasper C, Zahar A, Lausmann C, Hawi N, Citak M (2019) Serum C-reactive protein relationship in high- versus low-virulence pathogens in the diagnosis of periprosthetic joint infection. J Med Microbiol 68:910–917. https://doi.org/10.1099/jmm.0.000958
doi: 10.1099/jmm.0.000958
pubmed: 31017566
Morgenstern C, Cabric S, Perka C, Trampuz A, Renz N (2018) Synovial fluid multiplex PCR is superior to culture for detection of low-virulent pathogens causing periprosthetic joint infection. Diagn Microbiol Infect Dis 90:115–119. https://doi.org/10.1016/j.diagmicrobio.2017.10.016
doi: 10.1016/j.diagmicrobio.2017.10.016
pubmed: 29191466
Choi H-R, Beecher B, Bedair H (2013) Mortality after septic versus aseptic revision total hip arthroplasty: a matched-cohort study. J Arthroplasty 28:56–58. https://doi.org/10.1016/j.arth.2013.02.041
doi: 10.1016/j.arth.2013.02.041
pubmed: 23937921
Prange F, Seifert A, Piakong P, Gehrke T, Guttowski D, Busch S-M, Salber J, Citak M (2021) Short-term mortality after primary and revision total joint arthroplasty: a single-center analysis of 103,560 patients. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03731-w
Pöll AM, Baecker H, Yilmaz E, Jansen O, Waydhas C, Schildhauer TA, Hamsen U (2020) Risk factors and outcome of patients with periprosthetic joint infection admitted to intensive care unit. Arch Orthop Trauma Surg 140:1081–1085. https://doi.org/10.1007/s00402-020-03471-x
doi: 10.1007/s00402-020-03471-x
pubmed: 32388649
Rhee C, Lethbridge L, Richardson G, Dunbar M (2018) Risk factors for infection, revision, death, blood transfusion and longer hospital stay 3 months and 1 year after primary total hip or knee arthroplasty. Can J Surg 61:165–176. https://doi.org/10.1503/cjs.007117
doi: 10.1503/cjs.007117
pubmed: 29806814
pmcid: 5973904
Onochie E, Kayani B, Dawson-Bowling S, Millington S, Achan P, Hanna S (2019) Total hip arthroplasty in patients with chronic liver disease: a systematic review. SICOT J 5:40. https://doi.org/10.1051/sicotj/2019037
doi: 10.1051/sicotj/2019037
pubmed: 31674904
pmcid: 6824439
Lopez-de-Andres A, Hernandez-Barrera V, Martinez-Huedo MA, Villanueva-Martinez M, Jimenez-Trujillo I, Jimenez-Garcia R (2017) Type 2 diabetes and in-hospital complications after revision of total hip and knee arthroplasty. PLoS ONE 12:e0183796. https://doi.org/10.1371/journal.pone.0183796
doi: 10.1371/journal.pone.0183796
pubmed: 28837689
pmcid: 5570305
Viola J, Gomez MM, Restrepo C, Maltenfort MG, Parvizi J (2015) Preoperative anemia increases postoperative complications and mortality following total joint arthroplasty. J Arthroplasty 30:846–848. https://doi.org/10.1016/j.arth.2014.12.026
doi: 10.1016/j.arth.2014.12.026
pubmed: 25669131
Sharqzad AS, Cavalheiro C, Zahar A, Lausmann C, Gehrke T, Kendoff D, Parvizi J, Citak M (2019) Blood loss and allogeneic transfusion for surgical treatment of periprosthetic joint infection: a comparison of one- vs. two-stage exchange total hip arthroplasty. Int Orthop 43:2025–2030. https://doi.org/10.1007/s00264-018-4137-y
doi: 10.1007/s00264-018-4137-y
pubmed: 30187096
Gundtoft PH, Pedersen AB, Varnum C, Overgaard S (2017) Increased mortality after prosthetic joint infection in primary THA. Clin Orthop Relat Res 475:2623–2631. https://doi.org/10.1007/s11999-017-5289-6
doi: 10.1007/s11999-017-5289-6
pubmed: 28236084
pmcid: 5638726
Fischbacher A, Borens O (2019) Prosthetic-joint infections: mortality over the last 10 years. J Bone Joint Infect 4:198–202. https://doi.org/10.7150/jbji.35428
doi: 10.7150/jbji.35428
Thiesen DM, Sobhani H, Gehrke T, Suero EM, Klatte TO, Citak M (2020) A comparison of short term complication rate between 44 two- and 385 one-stage septic exchange arthroplasties in chronic periprosthetic joint infections. Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2020.05.008
doi: 10.1016/j.otsr.2020.05.008
pubmed: 32798125