PMU-Autor/inn/en
Bühren VolkerAbstract
INTRODUCTION
The aim of the study was to identify risk factors of failed two-stage procedures in cases of chronic posttraumatic periprosthetic hip infections.
Between 2006 and 2008, 26 patients with chronic posttraumatic periprosthetic infections after hip arthroplasty were included. In all cases operative bacterial eradication was initiated. The therapy was carried out according to a standardized treatment protocol including the eradication of the bacterial infection and the prosthetic replacement after three negative intra-operative specimens as a two-stage procedure. Follow-up was performed at least 2 years after revision procedure.
Twelve patients showed no signs of infectious recurrence 2 years after prosthetic hip revision therapy (46 %) and were assigned to group I. Group II is constituted by the other 14 patients (54 %). Four of them (16 %) suffered from an infectious recurrence after prosthetic hip replacement, ten patients (38 %) were characterised by a failed bacterial eradication. The spectrum of pathogens showed a significantly higher resistance pattern (p = 0.001) in group II, with a majority of methicillin-resistant Staphylococcus epidermidis (MRSE) and highly resistant Pseudomonas. In addition, patients of group II offered significantly higher American Society of Anesthesiology (ASA) scores (p = 0.015), the body mass index (BMI) was significantly elevated (p = 0.031) and received a significantly higher number of operative procedures (p = 0.016).
A reduced general state of health, a high BMI and highly resistant pathogens are the main risk factors for a failed two-stage procedure after chronic posttraumatic periprosthetic hip infections. Therefore, different treatment strategies are required for a defined subgroup of patients.
Useful keywords (using NLM MeSH Indexing)
Acetabulum/injuries*
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip/adverse effects*
Bacterial Infections/etiology*
Bacterial Infections/microbiology
Bacterial Infections/therapy
Chronic Disease
Female
Femoral Fractures/surgery*
Hip Fractures/surgery
Hip Joint/microbiology
Hip Joint/surgery*
Humans
Male
Middle Aged
Prosthesis Failure
Prosthesis-Related Infections/etiology*
Prosthesis-Related Infections/microbiology
Prosthesis-Related Infections/therapy
Reoperation
Retrospective Studies
Risk Factors
Treatment Failure
Young Adult