Outcomes of Revision Arthroplasty of Large Joints with Periprosthetic Infection

The article presents an analysis of the results of treatment of 62 patients with deep periprosthetic infection of the hip and knee joints who underwent revision arthroplasty. The age of the patients is from 37 to 81 years (mean age 62.7 ± 3.21 years). Men made 51.6 % of all patients. Periprosthetic infection after hip replacement occurred in 34 patients, knee joint - in 28 patients. There were 67 completed revision interventions.

The analysis showed that the use of revision endoprosthetics for periprosthetic infection made it possible to stop the infection process in 68.7 % of cases. In case of one-stage revision endoprosthesis replacement, unsatisfactory results in terms of stopping the infection process amounted to 31.8 % of cases. Of these, subsequently in 8 patients (57.1 %) the endoprosthesis was removed with the subsequent formation of ankylosis of the knee joint and neoarthrosis of the hip joint. An unsatisfactory result of two-stage revision endoprosthetics was obtained in 38.9 % of cases. Of these, in 6 cases (85.7 %), the infectious process was not stopped at the stage of spacer installation.

The analysis of cases of unsatisfactory results of revision endoprosthetics was carried out taking into account the method we developed for determining the surgical tactics of revision endoprosthetics of large joints in case of infectious complication, based on establishing the degree of risk of maintaining the infectious process. In addition, adverse factors that prevented the relief of periprosthetic infection were identified. As a result of the analysis, it was revealed that the reason for the unsatisfactory result of one-stage revision endoprosthetics in 12 cases was the wrong choice of the type of revision intervention. When planning a two-stage revision endoprosthesis replacement, it is necessary to take into account factors such as an allergy to antibacterial drugs, multiple surgical interventions on the affected joint, and extensive bone defects in the endoprosthesis area.

1. Shubnyakov II, Bozhkova SA, Artyukh VV, Liventsov VN, Kochish AA, Afanasyev AV. Immediate outcome of treatment for a patient with a periprosthetic hip infection. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2017; 4: 52-55. (In Russ.)

2. Ivanov PP, Kornilov NN, Kulyaba TA. Revision surgical procedures for periprosthetic knee joint infection (literature review). Kafedra travmatologii i ortopedii. 2017; 1(21): 38-46. (In Russ.)

3. Ermakov AM, Klyushin NM, Ababkov YuV, Tryapichnikov AS, Koyushkov AN. Evaluation of the effectiveness of two-stage surgical treatment of patients with periprosthetic infection of the knee and hip joints. Geniyortopedii. 2018; 24(3): 321-326. (In Russ.) doi: 10.18019/1028-4427-2018-24-3-321-326

4. Murylev VYu, Kukovenko GA, Elizarov PM, Ivanenko LR, Sorokina GL, Rukin YaA, Alekseev SS, Germanov VG. The algorithm of the first stage of treatment of late deep periprosthetic infection of the hip joint. Travmatologiya iortopediya Rossii. 2018; 24(4): 95104. (In Russ.) doi: 10.21823/2311-2905-2018-24-4-95-104

5. Leonova SN, Kameka AL, Grishchuk AN. The choice of tactics for revision arthroplasty of large joints with periprosthetic infection. Sibirskiymeditsinskiyzhurnal(Irkutsk). 2018; 154(3): 1114. (In Russ.)