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Two-stage revision for periprosthetic joint infection after hip and knee arthroplasty.
Straub, Jennifer; Staats, Kevin; Vertesich, Klemens; Kowalscheck, Lars; Windhager, Reinhard; Böhler, Christoph.
Afiliación
  • Straub J; Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
  • Staats K; Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
  • Vertesich K; Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
  • Kowalscheck L; Department of Pathology, Medical University of Vienna, Vienna, Austria.
  • Windhager R; Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
  • Böhler C; Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
Bone Joint J ; 106-B(4): 372-379, 2024 Apr 01.
Article en En | MEDLINE | ID: mdl-38555938
ABSTRACT

Aims:

Histology is widely used for diagnosis of persistent infection during reimplantation in two-stage revision hip and knee arthroplasty, although data on its utility remain scarce. Therefore, this study aims to assess the predictive value of permanent sections at reimplantation in relation to reinfection risk, and to compare results of permanent and frozen sections.

Methods:

We retrospectively collected data from 226 patients (90 hips, 136 knees) with periprosthetic joint infection who underwent two-stage revision between August 2011 and September 2021, with a minimum follow-up of one year. Histology was assessed via the SLIM classification. First, we analyzed whether patients with positive permanent sections at reimplantation had higher reinfection rates than patients with negative histology. Further, we compared permanent and frozen section results, and assessed the influence of anatomical regions (knee versus hip), low- versus high-grade infections, as well as first revision versus multiple prior revisions on the histological result at reimplantation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), chi-squared tests, and Kaplan-Meier estimates were calculated.

Results:

Overall, the reinfection rate was 18%. A total of 14 out of 82 patients (17%) with positive permanent sections at reimplantation experienced reinfection, compared to 26 of 144 patients (18%) with negative results (p = 0.996). Neither permanent sections nor fresh frozen sections were significantly associated with reinfection, with a sensitivity of 0.35, specificity of 0.63, PPV of 0.17, NPV of 0.81, and accuracy of 58%. Histology was not significantly associated with reinfection or survival time for any of the analyzed sub-groups. Permanent and frozen section results were in agreement for 91% of cases.

Conclusion:

Permanent and fresh frozen sections at reimplantation in two-stage revision do not serve as a reliable predictor for reinfection.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones Relacionadas con Prótesis / Artroplastia de Reemplazo de Cadera / Artroplastia de Reemplazo de Rodilla / Prótesis de Cadera / Prótesis de la Rodilla Límite: Humans Idioma: En Revista: Bone Joint J Año: 2024 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones Relacionadas con Prótesis / Artroplastia de Reemplazo de Cadera / Artroplastia de Reemplazo de Rodilla / Prótesis de Cadera / Prótesis de la Rodilla Límite: Humans Idioma: En Revista: Bone Joint J Año: 2024 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Reino Unido