A service evaluation into the outcomes of periprosthetic joint infections in total hip replacements and total knee replacements

Background: Total Hip Replacement (THR) and Total Knee Replacement (TKR) are staple procedures for end-stage arthritis and/or trauma in the young and elderly. One serious complication of these procedures is Peri-prosthetic Joint Infection (PJI) which is both equally difficult to diagnose and treat. Treatments vary from antibiotic administration to revision surgery (Debridement Antibiotics and Implant Retention [DAIR], One-stage or Two-stage) or a combination of both.Aims: to evaluate and examine the microbiological and surgical treatment options and outcomes for treating PJIs at the University Hospital Southampton (UHS) compared to existing literature.Methods: patients with PJI infections of THR or TKR were identified from an infection database, referred to microbiology from the Trauma and Orthopaedics department. A total of 124 patient were identified with only 112 patients satisfying the inclusion criteria. A qualitative measure was also enlisted through the Oxford Score (Knee and Hip) used as a secondary outcome measure.Results: 112 patients were included in the study with the mean age being 73 years old at patients’ latest operation. Of these, 38 had infected THR while 74 had infected TKR. 61% of THR were cured after initial treatment procedure while only 47% of TKR were cured. There was no significant different in treatment outcome of giving one intervention, be it surgical or pharmacological (i.e. antibiotics), over multiple. Three patients had an amputation after failed multiple revisions. Out of all the treatment modalities two-stage revision showed the most promising cure of infection with a success-rate of 77% (n=58