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The reasons for and mortality of patients unable to receive reimplantation after resection arthroplasty for chronic hip periprosthetic infection

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A Correction to this article was published on 19 January 2022

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Abstract

Background

Two-stage exchange arthroplasty is a feasible treatment for chronic PJI (periprosthetic joint infection) of total hip arthroplasty (THA). However, there are large numbers of patients who are unable to ultimately receive reimplantation after resection arthroplasty owing to uncontrolled infection and multiple comorbidities. The purpose of the current study was to identify patient-related risk factors and reasons for being unable to undergo revision THA.

Methods

Individuals undergoing resection arthroplasty for chronic PJI treatment from 2013 to 2020 at our institution were retrospectively reviewed. A variety of patient comorbidities, laboratory data, isolated pathogens, and follow-up status were collected for analysis.

Results

A total of 84 patients (46 men and 38 women) with a 2.7 ± 2.1-year follow-up were analyzed. Thirty-eight (45.2%) patients eventually underwent revision THA, while the other 46 (54.8%) did not receive reimplantation during follow-up. The patients without receiving reimplantation had higher Charlson comorbidity index (CCI) score (3.1 ± 2.9 versus 1.2 ± 1.5; p = 0.001). Lower cumulative incidence of receiving reimplantation was observed in patients with chronic kidney disease (log-rank test, p = 0.019), anemia (p = 0.011), presence of initial fever (p = 0.030), and oxacillin-resistant strain infection (p = 0.030). The most common reasons for not receiving reimplantation were uncontrolled infection, unstable medical conditions, and death. The patients without reimplantation had a relatively higher mortality rate (log-rank test, p = 0.002).

Conclusion

Chronic hip PJI with poor medical conditions or oxacillin-resistant strain infection decreased the chance of undergoing revision surgery. These patients had unfavourable outcomes and a higher mortality rate after resection arthroplasty.

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Data Availability

All data generated or analyzed during this study are included in this published article.

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Acknowledgements

This work was partially supported by a research grant from National Cheng Kung University Hospital.

Funding

This work was partially supported by a research grant from our hospital. No external funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, 70428, Tainan, Taiwan

    Yu-Hsuan Lin, Chao-Jui Chang, Chih-Wei Chang & Ta-Wei Tai

  2. Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Yi-Chen Chen

  3. Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Ta-Wei Tai

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Contributions

TWT contributes to conceptualization and methodology. YHL and CJC perform formal analysis and investigation. YHL was a major contributor in writing the manuscript. Writing — review and editing — was done by CWC and TWT. TWT and CYC contribute to revision. All authors read and approved the final manuscript.

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Correspondence to Ta-Wei Tai.

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Lin, YH., Chang, CJ., Chang, CW. et al. The reasons for and mortality of patients unable to receive reimplantation after resection arthroplasty for chronic hip periprosthetic infection. International Orthopaedics (SICOT) 46, 465–472 (2022). https://doi.org/10.1007/s00264-021-05254-4

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