Is two-stage reimplantation effective for virulent pathogenic infection in a periprosthetic hip? A retrospective analysis

Table 1 Comorbidities and frequencies

Comorbidities	No. of cases
Heart diseases, including hypertension	15
Uncontrolled diabetes mellitus	11
Liver cirrhosis	6
Repeated urinary tract infection	6
Brain lesions including stroke	4
Chronic gout	3
Psoriasis	2
Systemic lupus erythematosus	1
Chronic renal failure	2
Autoimmune hepatitis	1
Cushing’s syndrome	1
Asthma	1
Chronic obstructive pulmonary disease	1

Table 2 Analysis of factors affecting debridement and treatment of infected hip arthroplasty

Variable	No. of debridements (38 hips)			P value
	1 (n = 22)	2 (n = 10)	> 3 (n = 6)
Mean age (yr)	61.09	68.50	68.33	0.168
Infecting organism (n)				0.002
Methicillin sensitive	2	2
Resistant Staphylococcus	6	2	1
Vancomycin-resistant Enterococcus	2	1
Pseudomonas	1	2
Salmonella	1
Polymicrobial	1	3	5
Negative culture	9
Comorbidities (n)				< 0.001
0	10	1
1	8	2	1
2	2	5	2
3	2	2	1
4			1
5			1
Preoperative HHS				< 0.001
20-29			1
30-39		1	3
40-49	1	6	2
50-59	7	1
60-69	8	2
70-80	6

HHS: Harris hip score.

Table 3 Microbiological findings from 16 patients with periprosthetic hip infection who underwent multiple debridements (two or more)

Patient	Microorganism	No. of debridements
1	MRSA	2
2	Streptococcus parasanguis	2
3	Staphylococcus haemolyticus	2
4	Enterococcus faecalis (VRE)	2
5	MRSE	2
6	Pseudomonas aeruginosa	2
7	Pseudomonas stutzeri	2
8	MRSA, Acinetobacter baumannii	2
9	Enterococcus faecium (VRE), MRSA	2
10	Serratia marcescens, Acinetobacter baumannii	2
11	MRSE, Escherichia coli, Staphylococcus haemolyticus	3
12	MRSA	4
13	Salmonella, MRSE, MRSA	4
14	Acinetobacter baumannii, Proteus penneri, MRSA, Enterococcus faecium (VRE)	4
15	Pseudomonas aeruginosa, Acinetobacter baumannii	4
16	MRSA, MRSE, Pseudomonas aeruginosa, Enterococcus faecium (VRE)	7

MRSA: Methicillin resistant Staphylococcus aureus; MRSE: Methicillin-resistant Staphylococcus epidermidis; VRE: Vancomycin-resistant Enterococcus.

Table 4 Literature review: Two-stage treatment of infected hip arthroplasty

Ref.	Local cement device	Follow up (mo)	Infection control after first debridement	Infection control after reimplantation	Hips with resistant organisms	Successful control of infection
Hofmann et al[3]	Spacer	76	26/42 (62%)	26/27 (96%)	NA	NA
Salgado et al[11]	Spacer	6	28/45 (62%)	18/25 (72%)	12 (MRSA-12)	6/12 (50%)
Lim et al[35]	Spacer	54	38/45 (84%)	35/42 (83%)	24 (MRSA-14 MRCNS-10)	16/24 (67%)
Fink et al[2]	Spacer	35	40/40 (100%)	40/40 (100%)	3 (MRSA-3)	3/3 (100%)
Toulson et al[36]	Spacer	64.8	80/84 (95%)	80/84 (95%)	21 (MRSA-7, MRSE-12, VRE-2)	21/21 (100%)
Parvizi et al[25]	Spacer	12	61/127 (57%)	49/72 (67%)	66 (MRSA-34, MRSE-32)	48/66 (75%)
Romano et al[22]	Spacer	48	98/102 (96%)	98/102 (96%)	NA	NA
Leung et al[5]	Spacer	58	30/38 (79%)	30/38 (79%)	38 (MRSA-10, MRSE-26, Both-2)	30/38 (79%)
Uchiyama et al[12]	Spacer	48	33/36 (92%)	21/31 (67%)	15 (MRSA-10, MRCNS-4)	10/14 (71%)
Volin et al[10]	No spacer	48	43/46 (93%)	43/46 (93%)	9 (MRSA-2, MRCNS-7)	8/9 (89%)
Cordero-Ampuero et al[37]	No spacer	53	30/36 (83%)	20/20 (100%)	19 (MRSA-19)	17/19 (89%)
Van Diemen et al[26]	No spacer	96	118/136 (87%)	118/138 (87%)	7 (MRSA-7)	5/7 (71%)
Current study 2015	Spacer	64	37/38 (97%)	34/35 (97%)	26 (MRSA-4, MRSE-5, VRE-3, 1Poly-9)	25/26 (96%)

¹6 of 9 patients harbored resistant bacteria. MRSA: Methicillin resistant Staphylococcus aureus; MRSE: Methicillin-resistant Staphylococcus epidermidis; MRCNS: Methicillin-resistant coagulase-negative Staphyloccus; VRE: Vancomycin-resistant Enterococcus; NA: Not applicable; Poly: Polymicrobial infections.