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Negative Pressure Wound Therapy and Intermittent Irrigation with Systemic Antibiotic Suppression followed by One-stage Revision in Delayed Periprosthetic Hip Infection Cases: Reinfection Rate
Abstract
Background: Success rate of one-stage revision remains controversial in patients with delayed periprosthetic joint infection after primary cementless hip arthroplasty. We evaluated the reinfection-free efficacy of negative-pressure wound therapy (NPWT) and intermittent pulsatile irrigation (IPR) using chlorhexidine/povidone iodide combined with systemic antibiotic suppression (SAS) followed by one-stage exchange procedure with NPWT in those patients. Materials and Method: Reinfection rate was assessed in randomly selected forty-two cases (group A) with NPWT-IPR-SAS therapy prior to revision and thirty-nine cases (group B) with simple revision. The mean time between index procedure and presence of draining sinus was 6.8±3.1 months and 7.1±3.8 months, respectively, in two groups. The mean durations of sinus tract were 15.1±7.5 days and 17.2±6.7 days, respectively. Major pathogens were Coagulase Negative Staphylococcus, Klebsiella pneumonia and Escherchia coli. NPWT-IPR-SAS therapy was given for 9.8±4.1 days until index exchange procedure was performed in group A. All patients underwent the exchange arthroplasty using antibiotic impregnated cement. Results: In group A, serologic and clinical markers of infection were reduced markedly to meet fulfill our own designed criteria for revision and major systemic or local adverse events were not observed during pre-revision combination therapy. The mean duration of debridement and surgical invasiveness indices such as hemoglobin decrease, perioperative blood loss and transfusion were significantly lower in group A than in group B, all of which represented minimization of infected tissue volume. ESR and C-reactive protein levels were significantly lower in group A than in group B until 3 weeks after revision. In group A, the mean durations of parental and oral antibiotics administration were significantly shorter compared to group B. At final follow-up, reinfection rates were 2.4% and 43.6%, respectively, in two groups. Conclusion: Pre-revision NPWT-IPR-SAS therapy and post-revision NPWT could be effective tools for improving outcome of one-stage revision in patients with delayed periprosthetic hip infection.
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References
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