A comparison of short term complication rate between 44 two- and 385 one-stage septic exchange arthroplasties in chronic periprosthetic joint infections

Thiesen, Darius M.; Sobhani, Human; Gehrke, Thorsten; Suero, Eduardo M.; Klatte, Till O. und Citak, Mustafa (2021): A comparison of short term complication rate between 44 two- and 385 one-stage septic exchange arthroplasties in chronic periprosthetic joint infections. In: Orthopaedics & Traumatology-Surgery & Research, Bd. 107, Nr. 4, 102668

Abstract

Background: Periprosthetic joint infection is a serious disease with severe consequences for the patient's life. It is not known whether one-stage or two-stage replacement arthroplasty is superior. So far, there have been no studies on short-term complications between both surgical procedures. Therefore, we performed a retrospective study aiming to determine: 1) Does two-stage septic exchange arthroplasty have a higher short-term complication rate than one-stage? 2) Is there a difference in length of hospital stay and the in-hospital mortality rate between two-and one-stage septic exchange arthroplasty? Hypothesis: Two-stage septic exchange arthroplasty has a higher short-term complication rate than one stage. Patients and methods: Retrospectively 429 patients who underwent a one-or two stage revision arthroplasty (288 hips and 141 knees) due to chronic PJI between January 2015 and December 2016 were recruited (one-stage: n = 385, two-stage: n = 44). Differences in postoperative complications, surgical therapy, ASA, Charlson Comorbidity Index (CCI), length of hospital, need for plastic surgery, pathogen, in-hospital morbidity and in-hospital mortality were compared using multiple logistic and Poisson regression. Regarding comorbidities, age, gender and BMI the groups were comparable. Results: It was 3.5 times more likely to suffer from a medical complication if a two stage septic exchange was performed (OR 3.465, (95% CI: 2.573-4.358) [p < 0.01]). In medical complications the two-stage group showed significantly more events (two-stage: 9 of 44 = 20.5%;one-stage: 30 of 385 = 7.8% [p = 0.013]). The one-stage group showed more (not significant) nerve palsies after hip septic exchange. There was no difference in mortality between the groups (two-stage: 1/44 = 2.3%;one-stage: 3/385 = 0.8% [p = 0.882]), the overall mortality was 0.93%. The duration of hospital stay was 23.9 +/- 19 days for the one-stage and 42.2 +/- 17.7 days for the two-stage group (p < 0.001). Conclusion: We found that it is more likely to develop a medical complication after two-stage septic revision arthroplasty. There was no difference in overall surgical complications between the two surgical approaches. We did not find a significant difference in short term mortality between the two techniques, although the mortality rate was slightly higher in the two-stage group. Level of evidence: III, retrospective case control study. (c) 2020 Elsevier Masson SAS. All rights reserved.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1877-0568
• Sprache: Englisch