Outcomes and predictors of treatment failure following two-stage total joint arthroplasty with articulating spacers for evolutive septic arthritis

Autor: Feng-Chih Kuo, Jiying Chen, Wei Chai, Matthew Kheir, Xin Li, Chi Xu
Rok vydání: 2019
Předmět:
Male
lcsh:Diseases of the musculoskeletal system
Arthroplasty
Replacement
Hip
medicine.medical_treatment
Erythrocyte sedimentation rate
Prosthesis
Osteoarthritis
Hip
0302 clinical medicine
Risk Factors
Orthopedics and Sports Medicine
Treatment Failure
Arthroplasty
Replacement
Knee
030222 orthopedics
medicine.diagnostic_test
biology
Hazard ratio
Age Factors
Middle Aged
Osteoarthritis
Knee
Prognosis
Anti-Bacterial Agents
Preoperative Period
Total joint arthroplasty
Female
Research Article
Adult
medicine.medical_specialty
Blood Sedimentation
C-reactive protein
03 medical and health sciences
Rheumatology
Streptococcal Infections
medicine
Humans
Aged
Retrospective Studies
030203 arthritis & rheumatology
Arthritis
Infectious
Receiver operating characteristic
Interleukin-6
Proportional hazards model
business.industry
medicine.disease
Surgery
Orthopedic surgery
Septic arthritis
biology.protein
lcsh:RC925-935
business
Biomarkers
Follow-Up Studies
Zdroj: BMC Musculoskeletal Disorders, Vol 20, Iss 1, Pp 1-10 (2019)
BMC Musculoskeletal Disorders
ISSN: 1471-2474
Popis: Background The treatment strategy for evolutive septic arthritis (SA) with coexistent degenerative joint disease is not well established. The purposes of this study were to 1) investigate treatment outcome and potential risk factors of treatment failure in patients with evolutive SA following two-stage procedure, including insertion of an antibiotic-loaded spacer at the first stage and subsequent implantation of a new prosthesis; and 2) determine the performance of serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Interleukin-6 (IL-6) in predicting persisting infection at second-stage procedure. Methods We retrospectively reviewed 74 patients with evolutive SA of hips and knees who underwent a two-stage TJA between 2008 and 2015. The treatment success was defined according to the modified Delphi criteria and Kaplan-Meier survivorship curves were constructed to determine treatment success. A Cox regression model was performed to identify risk factors for treatment failure. Receiver operating characteristic (ROC) curves were generated to determine the prognostic value of ESR, CRP, and IL-6 in predicting persistent infection before second-stage prostheses implantation. Results Overall, the treatment success rate was 93% for hips and 100% for knees after the first-stage surgery. The treatment success rate was 89% for hips and 84% for knees after second-stage prosthesis implantation with a mean follow-up of 4.7 (range, 2.2 to 10.8) years. Older age (Hazard ratio [HR] [per 10-year increase], 1.20; 95% confidential interval [CI], 1.11 to 1.62), higher preoperative CRP level (HR [per 1-mg/dL increase], 1.15; 95% CI, 1.04 to 1.28) and resistant organism (HR, 13.96; 95% CI, 3.29 to 19.20) were associated with an increased risk of treatment failure. All serologic tests presented limited values in predicting persisting infection, with the area under ROC curve of ESR, CRP, IL-6 and combination of the three markers was 57.8, 61.6, 60.3, and 62.1%, respectively. Conclusions Two-stage TJA is an adequate management of infection control in patients with evolutive SA. The three potential risk factors (old age, high preoperative CRP, and resistant organism profile) may predict treatment failure following a two-stage procedure for evolutive SA. Additionally, serum ESR, CRP, and IL-6 had no benefit in predicting persisting infection before second-stage prostheses implantation. These findings may be useful when treating patients with evolutive SA.
Databáze: OpenAIRE
Externí odkaz: