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

Marjan Wouthuyzen-Bakker; Marine Sebillotte; ESCMID Study Group for Implant-Associated Infections (ESGIAI); Jose Lomas; Benjamin Kendrick; Eva Benavent Palomares; Oscar Murillo; Javad Parvizi; Noam Shohat; Javier Cobo Reinoso; Rosa Escudero Sánchez; Marta Fernandez-Sampedro; Eric Senneville; Kaisa Huotari; José Maria Barbero Allende; Antonio Blanco García; Jaime Lora-Tamayo; Matteo Carlo Ferrari; Danguole Vaznaisiene; Erlangga Yusuf; Craig Aboltins; Rihard Trebse; Mauro José Salles; Natividad Benito; Andrea Vila; Maria Dolores Del Toro; Tobias Siegfried Kramer; Sabine Petersdorf; Vicens Diaz-Brito; Zeliha Kocak Tufan; Marisa Sanchez; Cédric Arvieux; Alex Soriano

doi:10.1016/j.jinf.2019.07.003

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

Marjan Wouthuyzen-Bakker, Marine Sebillotte, ESCMID Study Group for Implant-Associated Infections (ESGIAI), Jose Lomas, Benjamin Kendrick, Eva Benavent Palomares, Oscar Murillo, Javad Parvizi, Noam Shohat, Javier Cobo Reinoso, Rosa Escudero Sánchez, Marta Fernandez-Sampedro, Eric Senneville, Kaisa Huotari, José Maria Barbero Allende, Antonio Blanco García, Jaime Lora-Tamayo, Matteo Carlo Ferrari, Danguole Vaznaisiene, Erlangga YusufCraig Aboltins, Rihard Trebse, Mauro José Salles, Natividad Benito, Andrea Vila, Maria Dolores Del Toro, Tobias Siegfried Kramer, Sabine Petersdorf, Vicens Diaz-Brito, Zeliha Kocak Tufan, Marisa Sanchez, Cédric Arvieux, Alex Soriano

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Abstract

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.

Original language	English
Pages (from-to)	199-205
Number of pages	7
Journal	Journal of Infection
Volume	79
Issue number	3
Early online date	30 Jul 2019
DOIs	https://doi.org/10.1016/j.jinf.2019.07.003
Publication status	Published - Sept 2019
Externally published	Yes

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Wouthuyzen-Bakker, M., Sebillotte, M., ESCMID Study Group for Implant-Associated Infections (ESGIAI), Lomas, J., Kendrick, B., Palomares, E. B., Murillo, O., Parvizi, J., Shohat, N., Reinoso, J. C., Sánchez, R. E., Fernandez-Sampedro, M., Senneville, E., Huotari, K., Allende, J. M. B., García, A. B., Lora-Tamayo, J., Ferrari, M. C., Vaznaisiene, D., ... Soriano, A. (2019). Timing of implant-removal in late acute periprosthetic joint infection: A multicenter observational study. Journal of Infection, 79(3), 199-205. https://doi.org/10.1016/j.jinf.2019.07.003

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

abstract = "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.",

author = "Marjan Wouthuyzen-Bakker and Marine Sebillotte and {ESCMID Study Group for Implant-Associated Infections (ESGIAI)} and Jose Lomas and Benjamin Kendrick and Palomares, {Eva Benavent} and Oscar Murillo and Javad Parvizi and Noam Shohat and Reinoso, {Javier Cobo} and S{\'a}nchez, {Rosa Escudero} and Marta Fernandez-Sampedro and Eric Senneville and Kaisa Huotari and Allende, {Jos{\'e} Maria Barbero} and Garc{\'i}a, {Antonio Blanco} and Jaime Lora-Tamayo and Ferrari, {Matteo Carlo} and Danguole Vaznaisiene and Erlangga Yusuf and Craig Aboltins and Rihard Trebse and Salles, {Mauro Jos{\'e}} and Natividad Benito and Andrea Vila and Toro, {Maria Dolores Del} and Kramer, {Tobias Siegfried} and Sabine Petersdorf and Vicens Diaz-Brito and Tufan, {Zeliha Kocak} and Marisa Sanchez and C{\'e}dric Arvieux and Alex Soriano",

year = "2019",

month = sep,

doi = "10.1016/j.jinf.2019.07.003",

language = "English",

volume = "79",

pages = "199--205",

number = "3",

}

Wouthuyzen-Bakker, M, Sebillotte, M, ESCMID Study Group for Implant-Associated Infections (ESGIAI), Lomas, J, Kendrick, B, Palomares, EB, Murillo, O, Parvizi, J, Shohat, N, Reinoso, JC, Sánchez, RE, Fernandez-Sampedro, M, Senneville, E, Huotari, K, Allende, JMB, García, AB, Lora-Tamayo, J, Ferrari, MC, Vaznaisiene, D, Yusuf, E, Aboltins, C, Trebse, R, Salles, MJ, Benito, N, Vila, A, Toro, MDD, Kramer, TS, Petersdorf, S, Diaz-Brito, V, Tufan, ZK, Sanchez, M, Arvieux, C & Soriano, A 2019, 'Timing of implant-removal in late acute periprosthetic joint infection: A multicenter observational study', Journal of Infection, vol. 79, no. 3, pp. 199-205. https://doi.org/10.1016/j.jinf.2019.07.003

TY - JOUR

T1 - Timing of implant-removal in late acute periprosthetic joint infection

T2 - A multicenter observational study

AU - Wouthuyzen-Bakker, Marjan

AU - Sebillotte, Marine

AU - ESCMID Study Group for Implant-Associated Infections (ESGIAI)

AU - Lomas, Jose

AU - Kendrick, Benjamin

AU - Palomares, Eva Benavent

AU - Murillo, Oscar

AU - Parvizi, Javad

AU - Shohat, Noam

AU - Reinoso, Javier Cobo

AU - Sánchez, Rosa Escudero

AU - Fernandez-Sampedro, Marta

AU - Senneville, Eric

AU - Huotari, Kaisa

AU - Allende, José Maria Barbero

AU - García, Antonio Blanco

AU - Lora-Tamayo, Jaime

AU - Ferrari, Matteo Carlo

AU - Vaznaisiene, Danguole

AU - Yusuf, Erlangga

AU - Aboltins, Craig

AU - Trebse, Rihard

AU - Salles, Mauro José

AU - Benito, Natividad

AU - Vila, Andrea

AU - Toro, Maria Dolores Del

AU - Kramer, Tobias Siegfried

AU - Petersdorf, Sabine

AU - Diaz-Brito, Vicens

AU - Tufan, Zeliha Kocak

AU - Sanchez, Marisa

AU - Arvieux, Cédric

AU - Soriano, Alex

PY - 2019/9

Y1 - 2019/9

N2 - 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.

AB - 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.

U2 - 10.1016/j.jinf.2019.07.003

DO - 10.1016/j.jinf.2019.07.003

M3 - Article

C2 - 31319141

VL - 79

SP - 199

EP - 205

IS - 3

ER -

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

Abstract

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