Comparison of Surgical Procedures in the Treatment of Hip Periprosthetic Infection

Branco, Ricardo Tomé; Rodrigues, Eurico Bandeira

doi:10.1055/s-0043-1776132

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Original Article • Rev. bras. ortop. 58 (5) • sep/oct 2023 • https://doi.org/10.1055/s-0043-1776132 copy

Comparison of Surgical Procedures in the Treatment of Hip Periprosthetic Infection

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective The present study aimed to compare the cure rate recovery time and Merle d'Aubigné-Postel functional (MAPF) score after single-stage surgery (C1T) or two-stage surgery (C2T) to treat prosthetic infections of the hip considering sociodemographic and clinical features of the patients.

Materials and Methods The present retrospective study occurred in a single center from 2011 to 2014 with 37 studied cases including 26 treated with C1T and 11 with C2T. We compared the cure rate recovery time and MAPF score in the two groups as well as the sociodemographic and clinical features of the patients. We also considered surgical complications and the most common infectious agents.

Results The C1T group had a faster functional recovery than the C2T group but there were no significant differences in the cure rate surgical complications or MAPF score. However C1T group patients were significantly younger which may have influenced the outcomes. Staphylococcus spp. was the most common infectious agent (62%).

Conclusion Although C2T appears superior regarding infection cure C1T may be preferable for faster functional recovery. However it is critical to consider individual patient characteristics when choosing treatment. Further research with a larger sample size is required to confirm these results.

Keywords
arthroplasty, replacement, hip; prosthesis-related infections; hip prosthesis; recovery of function; reoperation

Variables	Total	C1T	C2T	U	p-value	r
	n= 37 (100%)	n= 26 (70.3%)	n= 11 (29.7%)
	Median (IQR)	Median (IQR)	Median (IQR)
Age^a b Distinguishing whether the infection occurred in a primary implant or a revision implant. (in years)	74 (18.0)	77 (16.0)	64 (18.0)	83.0	.046	0.33
	n (%)	n (%)	n (%)		p-value^b c Number of any previous surgical procedure at the site of infection, except primary arthroplasty surgery.	φ
Sex
Male	21 (56.8)	15 (57.7)	6 (54.5)		1.000	0.029
Female	16 (43.2)	11 (42.3)	5 (45.5)		1.000	0.029

Variables	Total	C1T	C2T	p-value ^a	φ
	n = 37 (100%)	n = 26 (70.3%)	n = 11 (29.7%)
	n (%)	n (%)	n (%)
Infection ^b f Low-resistant agents include those known as easier to eliminate (non-methicillin-resistant Staphylococci), while high-resistant agents include agents those known as more difficult to eradicate (methicillin-resistant Staphylococci, Gram-negative agents, and polymicrobial cases).
Primary implant	14 (37.8)	10 (38.5)	4 (36.4)	1.000	0.020
Revision implant	23 (62.2)	16 (61.5)	7 (63.6)	1.000	0.020
	0^# c Quantifica qualquer procedimento cirúrgico prévio no local da infecção, à exceção da cirurgia de artroplastia primária.
Number of previous surgeries ^c g Charlson comorbidity index.
0	12 (32.4)	8 (30.8)	4 (36.4)	1.000	0.055
≥ 1	25 (67.6)	18 (69.2)	7 (63.6)	1.000	0.055
	0^# c Quantifica qualquer procedimento cirúrgico prévio no local da infecção, à exceção da cirurgia de artroplastia primária.
Infection time ^d h Surgical complications include perioperative fracture, perioperative hemorrhage, dysmetria, and neuronal injury (one case with an adverse reaction to rifampicin, consisting of erythema and anemia, was not considered a surgical complication).
< 4 weeks	6 (16.2)	6 (23.1)	0 (0.00)	0.151	0.286
≥ 4 weeks	31 (83.8)	20 (76.9)	11 (100)	0.151	0.286
	0^# c Quantifica qualquer procedimento cirúrgico prévio no local da infecção, à exceção da cirurgia de artroplastia primária.
Side ^e # Missing values. Significant p values (< 0.05) are shown in bold.
Left	16 (43.2)	14 (53.8)	2 (18.2)	0.071	0.329
Right	21 (56.8)	12 (46.2)	9 (81.8)	0.071	0.329
	0^# c Quantifica qualquer procedimento cirúrgico prévio no local da infecção, à exceção da cirurgia de artroplastia primária.
Infectious agent (resistance ^f b Teste exato de Fisher. Os valores de p significativos (< 0.05) estão representados em negrito. )
Low	13 (38.2)	10 (41.7)	3 (30.0)	0.704	0.109
High	21 (61.8)	14 (58.3)	7 (70.0)	0.704	0.109
	3^# c Quantifica qualquer procedimento cirúrgico prévio no local da infecção, à exceção da cirurgia de artroplastia primária.
Comorbidities (Charlson index ^g a Teste exato de Fisher. )
0	14 (37.8)	10 (38.5)	4 (36.4)	1.000	0.020
≥ 1	23 (62.2)	16 (61.5)	7 (63.6)	1.000	0.020
	0^# c Quantifica qualquer procedimento cirúrgico prévio no local da infecção, à exceção da cirurgia de artroplastia primária.
Complications ^h b Distingue se a infecção ocorreu em implante primário ou em implante de revisão.
Absent	29 (78.4)	21 (80.8)	8 (72.7)	0.672	0.089
Present	8 (21.6)	5 (19.2)	3 (27.3)	0.672	0.089
	0^# c Quantifica qualquer procedimento cirúrgico prévio no local da infecção, à exceção da cirurgia de artroplastia primária.

Organism	n (%)
Staphylococcus aureus	12 (32.4)
Coagulase-negative Staphylococci	11 (29.7)
Polymicrobial infections^a	7 (18.9)
Gram-negative agents	4 (10.8)
Unidentified organism	3 (8.1)
Total	37 (100)

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Ricardo Tomé Branco, MD, Serviço de Ortopedia e Traumatologia, Unidade Local de Saúde Alto Minho, 4904-858 Viana do Castelo, Portugal, ricardoptbranco@gmail.com