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Debridement, antibiotics and implant retention for prosthetic joint infection: comparison of outcomes between total hip arthroplasty and hip resurfacing

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Abstract

Introduction

The management of prosthetic joint infection (PJI) has been widely studied in the context of total hip arthroplasty (THA). However, the outcomes of debridement, antibiotics and implant retention (DAIR) for PJI have never been compared between hip resurfacing arthroplasty (HRA) and THA. This led us to carry out a retrospective case–control study comparing the surgical treatment of post-operative infections between HRA and THA to determine the infection remission rate and the medium-term functional outcomes.

Methods

This single-centre case–control study analysed 3056 HRA cases of which 13 patients had a PJI treated by DAIR. These patients were age-matched with 15 infected THA hips treated by DAIR and modular component exchange (controls). Their survival (no recurrence of the infection) was compared and factors that could affect the success of the DAIR were explored: sex, body mass index, age at surgery, presence of haematoma, type of bacteria present and antibiotic therapy.

Results

At a mean follow-up of five years (2–7), the infection control rate was significantly higher in the HRA group (100% [13/13]) than in the THA group (67% [10/15]) (p = 0.044). More patients in the THA group had undergone early DAIR (< 30 days) (73% [11/15]) than in the HRA group (54% [7/13]). There was no significant difference between the two groups in the ASA score, presence of comorbidities, body mass index and duration of the initial arthroplasty procedure. At the review, the Oxford-12 score of 17/60 (12–28) was better in the HRA group than the score of 25/60 (12–40) in the THA group (p = 0.004).

Conclusion

DAIR, no matter the time frame, is a viable therapeutic option for infection control after HRA.

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Acknowledgements

The authors are grateful to Joanne Archambault, PhD, for English language assistance.

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Authors and Affiliations

  1. Univ Lille, Hauts de France, 59000, Lille, France

    Enrick Castanet, Pierre Martinot, Julien Dartus, Eric Senneville, Henri Migaud & Julien Girard

  2. Orthopaedics Department, Hôpital Salengro, CHU Lille, Place de Verdun, 59000, Lille, France

    Enrick Castanet, Pierre Martinot, Julien Dartus, Eric Senneville, Henri Migaud & Julien Girard

  3. Hôpital Salengro, CHRU de Lille, Service d’Orthopédie 2Place de Verdun, 59037, Lille, France

    Pierre Martinot

  4. Infectious Diseases Department, Gustave Dron Hospital, 59200, Tourcoing, France

    Eric Senneville

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  1. Enrick Castanet
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Contributions

E. Castanet: collected and analysed the data.

P. Martinot: performed the operations, analysed the data, prepared and approved the manuscript.

J. Dartus: performed the operations, analysed the data, prepared and approved the manuscript.

E. Senneville: performed the antibiotics and infection management, prepared and approved the manuscript.

H. Migaud: performed the operations, prepared and approved the manuscript.

J. Girard: designed the study, performed the operations, prepared and approved the manuscript.

Corresponding author

Correspondence to Pierre Martinot.

Ethics declarations

Ethics approval

This study was conducted in accordance with principles of the Declaration of Helsinki and did not require ethics committee approval in France since it was conducted in a retrospective manner after obtaining patient authorization for use of their data.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Competing interests

Henri Migaud is an education and research consultant for Zimmer, Corin, SERF and MSD and chief editor for Orthopaedics & Traumatology: Surgery & Research (Elsevier). E. Senneville is paid consultant for Zimmer-Biomet. Julien Girard is an education and research consultant for MicroPort, Smith & Nephew and Zimmer-Biomet. All other authors declare no competing interests.

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Level of evidence: Level III, case-control study.

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Castanet, E., Martinot, P., Dartus, J. et al. Debridement, antibiotics and implant retention for prosthetic joint infection: comparison of outcomes between total hip arthroplasty and hip resurfacing. International Orthopaedics (SICOT) 46, 2799–2806 (2022). https://doi.org/10.1007/s00264-022-05522-x

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