J Bone Jt Infect 2019; 4(3):133-139. doi:10.7150/jbji.33039

Research Paper

First results of a uniform regional treatment protocol and registration for acute prosthetic join infection in the South-East of the Netherlands

Maud C. Kamp1,2, Robin W.T.M. van Kempen1, Loes Janssen3, M.C. (Marieke) van der Steen1,4✉ on behalf of the Regional Prosthetic Joint Infection working group

1. Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, The Netherlands.
2. Department of Orthopedic Surgery, Radboudumc , Postbus 9101, 6500 HB Nijmegen, the Netherlands.
3. Department of Orthopedic Surgery, VieCuri Medical Centre, Postbus 1926, 5900 BX Venlo, The Netherlands
4. Orthopaedic Center Máxima, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, The Netherlands.

Abstract

Introduction: Prosthetic joint infection (PJI) is a relatively uncommon (average incidence 0.5-2%) but devastating complication, with significant morbidity and leading to tremendously increased health care costs. In 2013, delegates from nine hospitals covering a large region in the South-East Netherlands composed one combined treatment protocol for acute PJI of total hip and knee arthroplasty (THA and TKA). This protocol was based on the definition of acute PJI according to Workgroup of the American Musculoskeletal Infection Society (MSIS) and the principles of debridement, antibiotics, irrigation and retention (DAIR).

Methods: Patients with a THA or TKA treated with DAIR because of suspicion of PJI were selected from the online PJI database. PJI was defined as at least two phenotypically identical pathogens, isolated in cultures from at least two separate tissues, obtained from the affected prosthetic joint. Acute PJIs, occurring within 90 days after primary implantation, between January 2014 and December 2016, were analyzed. We analyzed the PJI incidence rate, patient clinical and microbiological characteristics of PJI, outcome of the DAIR treatment and adherence to the regional protocol.

Results: A total of 310 primary THA or TKA with a suspected PJI were registered in the regional PJI database, 236 met the definition of acute PJI, representing overall incidence of 1.12%. Following the regional treatment protocol replacement of exchangeable parts took place in 45% in 2014 to 70% in 2016. After 12 months follow-up, prosthesis retention was achieved in 87% and 3% of the patients died within one year after the primary surgery.

Conclusion: Results of the regional cohort are in line with the available literature. Regional collaboration and regular feedback on registered data resulted in better adherence to the combined treatment protocol. Despite our attempts to improve PJI care, PJI remains a serious complication of THA and TKA with a significant mortality rate and burden for the patient.

Keywords: acute prosthetic join infection, debridement, antibiotics, irrigation, retention

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How to cite this article:
Kamp MC, van Kempen RWTM, Janssen L, van der Steen MCM. First results of a uniform regional treatment protocol and registration for acute prosthetic join infection in the South-East of the Netherlands. J Bone Jt Infect 2019; 4(3):133-139. doi:10.7150/jbji.33039. Available from http://www.jbji.net/v04p0133.htm