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Two-stage revision for the culture-negative infected total hip arthroplasty : A comparative study.

Abstract Periprosthetic joint infection (PJI) remains a challenging complication following total hip arthroplasty (THA). It is associated with high levels of morbidity, mortality and expense. Guidelines and protocols exist for the management of culture-positive patients. Managing culture-negative patients with a PJI poses a greater challenge to surgeons and the wider multidisciplinary team as clear guidance is lacking.
PMID
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Authors

Mayor MeshTerms
Keywords

Culture negative infection

Hip arthroplasty

Total hip replacement

Two-stage revision

Journal Title the bone & joint journal
Publication Year Start




PMID- 29292333
OWN - NLM
STAT- MEDLINE
DCOM- 20180104
LR  - 20180104
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 1 Supple A
DP  - 2018 Jan
TI  - Two-stage revision for the culture-negative infected total hip arthroplasty : A
      comparative study.
PG  - 3-8
LID - 10.1302/0301-620X.100B1.BJJ-2017-0626.R1 [doi]
AB  - AIMS: Periprosthetic joint infection (PJI) remains a challenging complication
      following total hip arthroplasty (THA). It is associated with high levels of
      morbidity, mortality and expense. Guidelines and protocols exist for the
      management of culture-positive patients. Managing culture-negative patients with 
      a PJI poses a greater challenge to surgeons and the wider multidisciplinary team 
      as clear guidance is lacking. PATIENTS AND METHODS: We aimed to compare the
      outcomes of treatment for 50 consecutive culture-negative and 50 consecutive
      culture-positive patients who underwent two-stage revision THA for chronic
      infection with a minimum follow-up of five years. RESULTS: There was no
      significant difference in the outcomes between the two groups of patients, with a
      similar rate of re-infection of 6%, five years post-operatively. Culture-negative
      PJIs were associated with older age, smoking, referral from elsewhere and
      pre-operative antibiotic treatment. The samples in the culture-negative patients 
      were negative before the first stage (aspiration), during the first-stage
      (implant removal) and second-stage procedures (re-implantation). CONCLUSION:
      Adherence to strict protocols for selecting and treating culture-negative
      patients with a PJI using the same two-stage revision approach that we employ for
      complex culture-positive PJIs is important in order to achieve control of the
      infection in this difficult group of patients. Cite this article: Bone Joint J
      2018;(1 Supple A)100-B:3-8.
CI  - (c)2018 The British Editorial Society of Bone and Joint Surgery.
FAU - Ibrahim, M S
AU  - Ibrahim MS
AD  - The Royal London, Whitechapel Road, London, E1 1BB, UK.
FAU - Twaij, H
AU  - Twaij H
AD  - Kingston Hospital, Galsworthy Road, London, UK.
FAU - Haddad, F S
AU  - Haddad FS
AD  - University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK and
      NIHR University College London Hospitals Biomedical Research Centre, UK.
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Arthroplasty, Replacement, Hip/instrumentation/*methods
MH  - Databases, Factual
MH  - Female
MH  - Follow-Up Studies
MH  - Hip Prosthesis/*adverse effects
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Prosthesis-Related Infections/diagnosis/*surgery
MH  - Recurrence
MH  - Reoperation/*methods
MH  - Risk Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Culture negative infection
OT  - Hip arthroplasty
OT  - Total hip replacement
OT  - Two-stage revision
EDAT- 2018/01/03 06:00
MHDA- 2018/01/05 06:00
CRDT- 2018/01/03 06:00
PHST- 2017/05/16 00:00 [received]
PHST- 2017/07/18 00:00 [accepted]
PHST- 2018/01/03 06:00 [entrez]
PHST- 2018/01/03 06:00 [pubmed]
PHST- 2018/01/05 06:00 [medline]
AID - 100-B/1_Supple_A/3 [pii]
AID - 10.1302/0301-620X.100B1.BJJ-2017-0626.R1 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 Jan;100-B(1 Supple A):3-8. doi:
      10.1302/0301-620X.100B1.BJJ-2017-0626.R1.