Spacer exchange prior to two-stage exchange for PJI yielded lower reimplantation success rates
PHILADELPHIA — Patients with periprosthetic joint infection experienced worse outcomes when they underwent debridement and spacer exchange prior to completing two-stage exchange, according to results presented at the Musculoskeletal Infection Society Annual Open Scientific Meeting.
“As we know, patients who fail [two-stage exchange] often go on to arthrodesis or perhaps amputation and so we think that if you are looking at a patient who is facing a spacer exchange, it is time to start thinking about the salvage procedures,” Andy O. Miller, MD, said in his presentation here.
Among 300 patients who had either hip or knee periprosthetic joint infection (PJI) treated with spacers and two-stage exchange, Miller said 14% required a spacer exchange. Of the patients whose knee required spacer exchange, Miller and colleagues found a success rate of 55% after reimplantation compared with a success rate of 76% among patients who did not require spacer exchange.
“In the hips it was similar, 70% success rate vs. 80% in the without spacer exchange,” Miller said. “This was significant with an increased odds ratio of 2.6 more likely to fail if you needed a spacer exchange.”
Total results showed an association between spacer exchange and outcomes, according to Miller.
“In the hips, it was not significant and then separate, we looked at age, sex and BMI which did not seem to make a difference in our cohort,” Miller said. – by Casey Tingle
Henry M, et al. The infected spacer: The impact of spacer exchanges and debridement on two-stage exchange arthroplasty outcomes. Presented at: Musculoskeletal Infection Society Annual Open Scientific Meeting; July 27-28, 2018; Philadelphia.
Disclosure: Miller reports no relevant financial disclosures.