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Year : 2019  |  Volume : 37  |  Issue : 1  |  Page : 67--71

Microbiological profile and outcomes of two-stage revision hip arthroplasty

TD Hariharan1, VJ Chandy1, Jerry George1, Ajit Joseph Mathew1, John Premnath1, Agila Kumari Pragasam2, John Jude Prakash2, Anil Thomas Oomen1, Pradeep Mathew Poonnoose1 
1 Department of Orthopaedic Surgery, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. V J Chandy
Department of Orthopaedic Surgery, Christian Medical College, Vellore, Tamil Nadu
India

Background: Prosthetic joint infection (PJI) is one of the most challenging cases that confront modern orthopaedics. Two-stage revision, which is the standard of care for PJI, is the preferred mode of treatment for these infections. Aims and Objectives: To study the microbiological profile of prosthetic joint infections (PJI) in the hip and to assess the efficacy of a two stage revision surgery for PJI. We also aimed to study the sensitivity and specificity of ESR and CRP in the diagnosis of PJI. Materials and Methods: The microbiological profile, clinical and radiological outcomes of 22 patients who had a two-stage revision for PJI of the hip between 2013 and 2017 were retrospectively analysed. PJI was defined using the criteria provided by the International Consensus Statement on PJI 2013. Results: Staphylococcus aureus was found to be the most common organism in PJI. Debridement was successful in removing the organism in 74% of PJI. At the time of re-implantation (second stage), six joints grew organisms that were different from that isolated at the index debridement - coagulase-negative staphylococci (3cases) and enterococci (3cases). Other infection parameters for these patients were negative. None of the patients who had two-stage revision surgery had clinical evidence of reinfection or radiological evidence of loosening at a mean of 2-year follow-up. An ESR cut off of >30mm/hr had a sensitivity of 75% and specificity of 88% in predicting PJI. A CRP >10mg/L had a sensitivity of 75% and specificity of 69%. The sensitivity and specificity of using both ESR and CRP cut-offs in the diagnosis of infection were 57% and 94%, respectively. The positive predictive value was 94% and negative predictive value was 56%. Conclusion: The outcomes of the study justify a two-stage revision arthroplasty for PJI of the hip. The use of ESR and CRP as screening tests for the success of debridement has value - but should be interpreted with caution.

How to cite this article:
Hariharan T D, Chandy V J, George J, Mathew AJ, Premnath J, Pragasam AK, Prakash JJ, Oomen AT, Poonnoose PM. Microbiological profile and outcomes of two-stage revision hip arthroplasty.Indian J Med Microbiol 2019;37:67-71

How to cite this URL:
Hariharan T D, Chandy V J, George J, Mathew AJ, Premnath J, Pragasam AK, Prakash JJ, Oomen AT, Poonnoose PM. Microbiological profile and outcomes of two-stage revision hip arthroplasty. Indian J Med Microbiol [serial online] 2019 [cited 2020 Jul 5 ];37:67-71
Available from: http://www.ijmm.org/article.asp?issn=0255-0857;year=2019;volume=37;issue=1;spage=67;epage=71;aulast=Hariharan;type=0