Artikel
What is the safe distance between hip and knee implants to reduce the risk of ipsilateral metachronous periprosthetic joint infection?
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Autoren
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Mustafa Akkaya
- Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
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Georges Vles
- Department of Orthopaedic Surgery, UZ Leuven, Leuven, Belgium
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Rudy Sangaletti
- Department of Orthopaedic Surgery Brescia Hospital, Brescia, Italy
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Luigi Zanna
- University of Florence, Firenze, Italy
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Thorsten Gehrke
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik, Hamburg, Germany
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Mustafa Citak
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik, Hamburg, Germany
| Veröffentlicht: | 23. Oktober 2023 |
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Gliederung
Text
Objectives: Periprosthetic joint infection (PJI), the most common cause of revision after TKA and THA, is a devastating complication for patients that is difficult to diagnose and treat. An increase in the number of patients with multiple joint arthroplasties in the same extremity will result in an increased risk of ipsilateral PJI. However, there is no definition of risk factors, micro-organism patterns, and safe distance between knee and hip implants for this patient group. Our research questions:
- 1.
- In patients with hip and knee arthroplasties on the same side who experience a PJI of one implant, are there factors associated with the development of subsequent PJI of the other implant?
- 2.
- In this patient group, how often is the same organism responsible for both PJIs?
- 3.
- Is a shorter distance from an infected prosthetic joint to an ipsilateral prosthetic joint associated with greater odds of subsequent infection of the second joint?
Methods: We retrospectively identified all one- and two-stage procedures performed for PJI of the hip and knee at our tertiary referral arthroplasty center between January 2010 and December 2018. The patients who had an ipsilateral hip or knee replacement in situ at the time of receiving surgical treatment for a PJI of the hip or knee were collected. After the exclusion criteria the remaining 98 patients were included in the final analysis.
Results: A total of 20 out of the 98 patients (20.4%) developed ipsilateral metachronous PJI during the study period. The mean time between the initial PJI and ipsilateral metachronous PJI was 8.3±14.0 months. It was found that the 20 patients who went on to have an ipsilateral metachronous PJI had significant shorter stem-to-stem distance (p = 0.001), shorter empty native bone distance (p = 0.0001) and a higher rate of cement stop failure (p = 0.0001) than the 78 patients that did not develop ipsilateral metachronous PJI during the study period.
Conclusion: On the basis of these results, we advise maintaining a minimum of 7 cm of native bone between the uninfected implant and the implant being revised for PJI of the hip or knee in order to reduce the risk of ipsilateral metachronous periprosthetic joint infection.
