{"corpus_id":8041386,"paper_sha":"f81c3a5ad2a15bce7c7c75fe1f5b642e347ae26b","doi":"10.3109/17453674.2013.858288","arxiv_id":null,"pmid":24171687,"pmcid":"3851662","mag_id":2091764958,"dblp_id":null,"acl_id":null,"title":"Good results in postoperative and hematogenous deep infections of 89 stable total hip and knee replacements with retention of prosthesis and local antibiotics","year":2013,"publication_date":"2013-12-01","venue":"Acta Orthopaedica","journal":{"name":"Acta Orthopaedica","pages":"509 - 516","volume":"84"},"journal_issn":null,"journal_title":null,"publication_types":["JournalArticle"],"pubmed_pub_types":["Journal Article"],"s2_fields_of_study":["Medicine"],"reference_count":34,"citation_count":79,"influential_citation_count":1,"is_open_access":true,"arxiv_categories":null,"arxiv_license":null,"arxiv_journal_ref":null,"mesh_headings":[{"d":"Administration, Topical","mj":false,"ui":"D000287"},{"d":"Adult","mj":false,"ui":"D000328"},{"d":"Aged","mj":false,"ui":"D000368"},{"d":"Aged, 80 and over","mj":false,"ui":"D000369"},{"d":"Anti-Bacterial Agents","mj":false,"qs":[{"q":"administration & dosage","mj":true,"ui":"Q000008"},{"q":"therapeutic use","mj":false,"ui":"Q000627"}],"ui":"D000900"},{"d":"Arthroplasty, Replacement, Hip","mj":false,"ui":"D019644"},{"d":"Arthroplasty, Replacement, Knee","mj":false,"ui":"D019645"},{"d":"Bacterial Infections","mj":false,"qs":[{"q":"drug therapy","mj":true,"ui":"Q000188"},{"q":"microbiology","mj":false,"ui":"Q000382"},{"q":"surgery","mj":false,"ui":"Q000601"}],"ui":"D001424"},{"d":"Combined Modality Therapy","mj":false,"ui":"D003131"},{"d":"Debridement","mj":false,"ui":"D003646"},{"d":"Drug Carriers","mj":false,"ui":"D004337"},{"d":"Female","mj":false,"ui":"D005260"},{"d":"Gentamicins","mj":false,"qs":[{"q":"administration & dosage","mj":false,"ui":"Q000008"},{"q":"therapeutic use","mj":false,"ui":"Q000627"}],"ui":"D005839"},{"d":"Hip Prosthesis","mj":false,"qs":[{"q":"adverse effects","mj":true,"ui":"Q000009"},{"q":"microbiology","mj":false,"ui":"Q000382"}],"ui":"D006622"},{"d":"Humans","mj":false,"ui":"D006801"},{"d":"Knee Prosthesis","mj":false,"qs":[{"q":"adverse effects","mj":true,"ui":"Q000009"},{"q":"microbiology","mj":false,"ui":"Q000382"}],"ui":"D007720"},{"d":"Male","mj":false,"ui":"D008297"},{"d":"Methylmethacrylates","mj":false,"qs":[{"q":"administration & dosage","mj":false,"ui":"Q000008"},{"q":"therapeutic use","mj":false,"ui":"Q000627"}],"ui":"D008768"},{"d":"Middle Aged","mj":false,"ui":"D008875"},{"d":"Postoperative Period","mj":false,"ui":"D011184"},{"d":"Prosthesis Failure","mj":false,"ui":"D011475"},{"d":"Prosthesis-Related Infections","mj":false,"qs":[{"q":"drug therapy","mj":true,"ui":"Q000188"},{"q":"microbiology","mj":false,"ui":"Q000382"},{"q":"surgery","mj":false,"ui":"Q000601"}],"ui":"D016459"},{"d":"Retrospective Studies","mj":false,"ui":"D012189"},{"d":"Risk Assessment","mj":false,"qs":[{"q":"methods","mj":false,"ui":"Q000379"}],"ui":"D018570"},{"d":"Treatment Outcome","mj":false,"ui":"D016896"}],"chemicals":[{"n":"Anti-Bacterial Agents","ui":"D000900","reg":"0"},{"n":"Drug Carriers","ui":"D004337","reg":"0"},{"n":"Gentamicins","ui":"D005839","reg":"0"},{"n":"Methylmethacrylates","ui":"D008768","reg":"0"},{"n":"gentamicin-polymethylmethacrylate bead","ui":"C030159","reg":"0"}],"comments_corrections":null,"source_flags":5,"s2_open_access_pdf_url":"https://actaorthop.org/actao/article/download/10256/13962","s2_open_access_landing_url":"https://www.semanticscholar.org/paper/f81c3a5ad2a15bce7c7c75fe1f5b642e347ae26b","s2_open_access_license":"CCBYNC","s2_open_access_status":"GOLD","pmc_open_access_pdf_url":null,"pmc_open_access_landing_url":null,"pmc_open_access_license":null,"pmc_open_access_status":null,"unpaywall_open_access_pdf_url":null,"unpaywall_open_access_landing_url":null,"unpaywall_open_access_license":null,"unpaywall_open_access_status":null,"abstract":"Background Deep postoperative and hematogenous prosthesis infections may be treated with retention of the prosthesis, if the prosthesis is stable. How long the infection may be present to preclude a good result is unclear. Patients and methods We retrospectively studied 89 deep-infected stable prostheses from 69 total hip replacements and 20 total knee replacements. There were 83 early or delayed postoperative infections and 6 hematogenous. In the postoperative infections, treatment had started 12 days to 2 years after implantation. In the hematogenous infections, symptoms had been present for 6 to 9 days. The patients had been treated with debridement, prosthesis retention, systemic antibiotics, and local antibiotics: gentamicin-PMMA beads or gentamicin collagen fleeces. The minimum follow-up time was 1.5 years. We investigated how the result of the treatment had been influenced by the length of the period the infection was present, and by other variables such as host characteristics, infection stage, and type of bacteria. Results In postoperative infections, the risk of failure increased with a longer postoperative interval: from 0.2 (95% CI: 0.1–0.3) if the treatment had started ≥ 4 weeks postoperatively to 0.5 (CI: 0.2–0.8) if it had started at ≥ 8 weeks. The relative risk for success was 0.6 (CI: 0.3–0.95) if the treatment had started ≥ 8 weeks. In the hematogenous group, 5 of 6 infections had been treated successfully. Interpretation A longer delay before the start of the treatment caused an increased failure rate, but this must be weighed against the advantage of keeping the prosthesis. We consider a failure rate of < 50% to be acceptable, and we therefore advocate keeping the prosthesis for up to 8 weeks postoperatively, and in hematogenous infections with a short duration of symptoms.","claims":[{"public_id":"cl_d6d5d9b5a3c4d21e036b9c7da037ca41","status":"active","text":"Five of six hematogenous infections were successfully treated with prosthesis retention when symptom duration was short.","confidence":0.94,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_d6d5d9b5a3c4d21e036b9c7da037ca41"},{"public_id":"cl_74244d418f6858e57c54c5cd31aade68","status":"active","text":"In postoperative infections, failure risk increased as the delay before treatment lengthened, rising from 0.2 when treatment started at least 4 weeks after implantation to 0.5 when it started at least 8 weeks after implantation.","confidence":0.98,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_74244d418f6858e57c54c5cd31aade68"},{"public_id":"cl_84dabcaafc6a6fb1daf7acbbf58747db","status":"active","text":"Keeping the prosthesis is considered acceptable when the expected failure rate is below 50%, supporting retention up to 8 weeks postoperatively and in hematogenous infections with short symptom duration.","confidence":0.91,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_84dabcaafc6a6fb1daf7acbbf58747db"},{"public_id":"cl_3ef56389d0c7c4656e10d6e65e8f51f9","status":"active","text":"Retaining a stable prosthesis with debridement, systemic antibiotics, and local gentamicin delivery achieved good outcomes in most postoperative and hematogenous deep infections.","confidence":0.96,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_3ef56389d0c7c4656e10d6e65e8f51f9"},{"public_id":"cl_70c67c59b9366aa50e3046fabf65f79c","status":"active","text":"The relative risk for success was 0.6 when treatment started at least 8 weeks after implantation.","confidence":0.93,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_70c67c59b9366aa50e3046fabf65f79c"}],"concepts":[{"public_id":"co_01f96e5a5d9e4d6442c7126a1d981f51","status":"active","name":"stable prosthesis","description":"A hip or knee implant that remains mechanically stable during infection treatment.","types":["medical device"],"aliases":["stable 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