Validity of a preoperative scoring system for surgical management of periprosthetic hip infection: one-stage vs. two-stage revision

Kenichi Oe; Hirokazu Iida; Yosuke Otsuki; Takashi Toyoda; Fumito Kobayashi; Shohei Sogawa; Tomohisa Nakamura; Takanori Saito

doi:10.1007/s00402-024-05279-5

Validity of a preoperative scoring system for surgical management of periprosthetic hip infection: one-stage vs. two-stage revision

Arch Orthop Trauma Surg. 2024 Apr 25. doi: 10.1007/s00402-024-05279-5. Online ahead of print.

Authors

Kenichi Oe¹, Hirokazu Iida², Yosuke Otsuki², Takashi Toyoda², Fumito Kobayashi², Shohei Sogawa², Tomohisa Nakamura², Takanori Saito²

Affiliations

¹ Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan. oeken@hirakata.kmu.ac.jp.
² Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.

PMID: 38662000
DOI: 10.1007/s00402-024-05279-5

Abstract

Introduction: There are no widely accepted algorithms for determining optimal treatment for periprosthetic joint infection (PJI). Our study aimed to confirm the validity of a previously published scoring system in a larger number of patients to support a rational surgical treatment strategy for periprosthetic hip infection.

Materials and methods: Between February 2001 and December 2020, we performed 155 consecutive revision total hip arthroplasties (THAs) for PJI, with mean follow-up of 6 years. One-stage revision THA was performed in 56 hips and two-stage revision THA in 99 hips. Prosthesis survival from recurrent infection was determined by Kaplan-Meier analysis, using implant removal as the endpoint. The pre-operative scoring system (full score of 12 points), including 6 essential elements, was retrospectively evaluated.

Results: The 10-year survival rates were 98% for one-stage (95% confidence interval [CI], 94-100) and 87% (95% CI, 79-96) for two-stage revision THA. Multivariate Cox regression analysis provided a total preoperative score as an independent risk factor for implant removal (hazard ratio, 0.17; 95% CI, 0.06-0.49; p < 0.001). The sensitivity and specificity at the cut-off of 4 points on the scoring system were 80% and 91%, respectively. The average score for one-stage revision THA in successful and failed cases were 8.9 and 6.0, and for two-stage revision THA were 6.5 and 3.9, respectively. We found significant differences between successful cases in one- and two-stage revision THA (p < 0.05).

Conclusions: The preoperative scoring system was useful for managing PJI. One-stage revision THA is recommended in patients scoring ≥ 9 points, and meticulously performed two-stage revision THA is encouraged for patients scoring ≥ 4 points.

Keywords: Infection; One-stage revision; Scoring system; Total hip arthroplasty; Two-stage revision.