Rethinking the Definition of Success in the Management of a Periprosthetic Joint Infection
The Journal of Bone & Joint Surgery SEPT.16, 2015 V.97 N.18 e64
Commentary on an article by Miguel M. Gomez, MD, et al.: “The Fate of Spacers in the Treatment of Periprosthetic Joint Infection”
In the article “The Fate of Spacers in the Management of Periprosthetic Joint Infection,” Gomez et al. raise two important questions with regard to the treatment of periprosthetic joint infection: What occurs with the patient during the interim between staged surgical treatments; and what occurs with the patient who does not undergo the subsequent stage of treatment?
This information is valuable as most reports on the outcome of a two-stage treatment for periprosthetic joint infection, in which infection eradication is attained in 85% to 90% of patients, have focused on showing results only for patients who completed the second stage. From their findings, Gomez et al. suggest that this may overestimate the rate of infection eradication, as some of these treated patients may have a subsequent infection. Equally importantly, the point is made that there are other possible outcomes after the index removal of the implant (failure to proceed with the second stage, surgical treatment other than reimplantation, amputation, fusion, resection arthroplasty, spacer retention, and death) that need to be described. The combination of reporting the success of the two-stage treatment and reporting the failures as defined above yields a much fuller picture of the impact of a periprosthetic joint infection. The authors are to be commended for asking and attempting to answer questions of great clinical import and in expanding the criteria for what defines a successful outcome….
Entry filed under: Antimicrobianos, Bacterias, Epidemiología, FIEBRE en el POSTOPERATORIO, Health Care-Associated Infections, Infecciones en piel y tej blandos, Infecciones osteo-articulares-musculares, Infecciones relacionadas a prótesis, Infecciones sitio quirurgico, Metodos diagnosticos, Resistencia bacteriana, Sepsis, Update.