Abstract

GARCIA-BARREIRO, Gonzalo et al. ¿Qué factores hacen fallar un reimplante de cadera luego de una revisión en dos tiempos?. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2021, vol.86, n.4, pp.501-511. ISSN 1852-7434.  http://dx.doi.org/https://doi.org/10.15417/issn.1852-7434.2021.86.4.1325.

Background: We analyzed the survivorship free-from-septic failure in a series of THA cases treated with a two-stage protocol at long-term follow-up, with a special focus on the relevance of positive frozen section and positive intraoperative culture taken during the reimplantation. Materials and Methods: We retrospectively reviewed data from 96 cases who met the Musculoskeletal Infection Society criteria for periprosthetic joint infection and who had undergone both stages of a two-stage protocol at our institution between 2008-2013. Mean follow-up was 90 months. Treatment failure was determined with a modified Delphi-based consensus definition. Kaplan-Meier estimate was used to determine survivorship free-from-septic failure. Log-Rank test was used to compare variables associated with septic failure. Results: Survival free-from-septic failure was 82.65% at 2 years (95%CI 73.25%-88.99%), 80.40% at 5 years (95%CI 70.70%-87.17%) and 77.32% at 6-10 years (95%CI 66.90%-84.33%). Patients with a positive culture at reimplantation had significantly more septic failures than those without it (Log-Rank test, p=0.0208), while patients with a positive frozen section at reimplantation had significantly more septic failures than those without it (Log-Rank test, p=0.0154). Conclusions: Reimplantations that remained at least 6 years without septic recurrences had a very low risk of further septic failure. Both positive frozen section and intraoperative culture at reimplantation were risk factors for septic failure.

Keywords : Periprosthetic joint infection; total hip replacement; two-stage revision surgery.

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