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Debridement to treat infection had high failure rate after hemiarthroplasty

Debridement to treat infection had high failure rate after hemiarthroplasty

August 09, 2022

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Bourget-Murray J, et al. Paper 1033. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 5-6, 2022; Pittsburgh (hybrid meeting).

Tubin reports no relevant financial disclosures.

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Debridement, antibiotics and implant retention yielded a high failure rate when used to treat periprosthetic joint infection after hemiarthroplasty, according to results presented at the Musculoskeletal Infection Society Annual Meeting.

“Further prospective studies are required to provide high-level evidence regarding hemiarthroplasty [periprosthetic joint infection] PJI and its associated treatment options,” Nicholas Tubin said in his presentation here.

Tubin and colleagues retrospectively collected patient demographics and PJI parameters among 1,984 hemiarthroplasties performed to treat hip fracture between 2010 and 2021. Researchers categorized patients based on whether they underwent debridement, antibiotics and implant retention (DAIR); revision arthroplasty; single-stage revision to hemiarthroplasty or single-stage revision to total hip arthroplasty.

“Treatment success was defined as infection control and a minimum of 12 months with or without suppressive antibiotics,” Tubin said. “Treatment failure was defined as per the Delphi-based international multidisciplinary consensus definition.”

Overall, Tubin noted 44 hemiarthroplasties developed a PJI, with an overall incidence of hemiarthroplasty PJI of 2.2%.

“Multiple logistic regression analyses revealed that a higher [Charlson Comorbidity Index] CCI, peripheral vascular disease, cerebral vascular disease, diabetes, renal disease and cancer with and without metastases were associated with an increasing PJI risk following hemiarthroplasty for hip fracture,” Tubin said.

According to Tubin, 38.6% of initial PJI treatments failed and required further surgery. Within the year following PJI, Tubin added 22.2% of patients died. He noted an association between lower preoperative hemoglobin levels, elevated C-reactive protein levels, early onset PJI of less than 6 weeks and non-arthroplasty-trained surgeons as the operating surgeons with treatment failure.

“The type of surgery was also associated with outcome, with the highest failure rate found in DAIR at 57.7% when compared to revision hemiarthroplasty with a failure rate of 33.3%, followed then by revision to a total hip arthroplasty that carried a failure rate of 0%,” Tubin said.