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Two-Stage Primary Arthroplasty of Native Hips and Knees That Had Previously Failed Treatment for Septic Arthritis: A Single-Center Experience.

ABSTRACT: Background:Patients with a history of degenerative joint disease secondary to an acute or remote episode of septic arthritis of the native knee or hip present a unique challenge for the orthopaedic surgeon. This study describes our experience with two-stage primary arthroplasty for such patients. Methods:We reviewed 42 patients with a history of septic arthritis treated with two-stage primary arthroplasty between 2008 and 2018. Patients were evaluated using modified Harris Hip Score, Knee Society Score (KSS), and KSS functional component (KSSF). Paired t-tests were used to compare changes for continuous variables within cohorts. Multivariate linear and logistic regression models were constructed to determine predictors of outcomes and complications. Results:At a mean of 3.3-year follow-up, there were 14 (33.3%) complications and the infection cure rate was 95.2%. On average, patients improved in the modified Harris Hip Score (42.9 ± 11.8 vs 83.3 ± 11.1, P < .001), KSS (35.9 ± 16.9 vs 80.1 ± 16.6, P < .001), KSSF (38.0 ± 15.1 vs 71.5 ± 24.0, P < .001), knee flexion (90.9 ± 14.9 vs 100.5 ± 17.1), and hip flexion (73.8 ± 21.2 vs 102.1 ± 11.8, P < .001). Age (?: -0.78, P = .004) was independently associated with lower Harris Hip Score in the hip cohort. There were no independent predictors of the KSS or KSSF. The erythrocyte sedimentation rate (odds ratio: 1.07, P = .043) and C-reactive protein (odds ratio: 1.43, P = .018) at stage 2 were independently associated with a higher likelihood of complications at the final follow-up. Conclusion:Patients with a history of native septic arthritis of the hip and knee, and secondary end-stage degenerative joint disease, showed significant postoperative improvements and a high rate of complications after two-stage primary total joint arthroplasty. Despite improvements, some patients may necessitate a third operation because of the incidence of reinfection and spacer exchange. This information should be used to counsel patients who present with this challenging clinical scenario.

SUBMITTER: Kunze KN

PROVIDER: S-EPMC7316870 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Two-Stage Primary Arthroplasty of Native Hips and Knees That Had Previously Failed Treatment for Septic Arthritis: A Single-Center Experience.

Kunze Kyle N KN Sadauskas Alexander J AJ Kernzer Benjamin B Levine Brett R BR

Arthroplasty today 20200623 3

<h4>Background</h4>Patients with a history of degenerative joint disease secondary to an acute or remote episode of septic arthritis of the native knee or hip present a unique challenge for the orthopaedic surgeon. This study describes our experience with two-stage primary arthroplasty for such patients.<h4>Methods</h4>We reviewed 42 patients with a history of septic arthritis treated with two-stage primary arthroplasty between 2008 and 2018. Patients were evaluated using modified Harris Hip Sco ...[more]

PMID: 32613049

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Project description:To evaluate hematological, cytogenetic and molecular responses as well as the overall, progression-free and event-free survivals of chronic myeloid leukemia patients treated with a third tyrosine kinase inhibitor after failing to respond to imatinib and nilotinib/dasatinib.Bone marrow karyotyping and real-time quantitative polymerase chain reaction were performed at baseline and at 3, 6, 12 and 18 months after the initiation of treatment with a third tyrosine kinase inhibitor. Hematologic, cytogenetic and molecular responses were defined according to the European LeukemiaNet recommendations. BCR-ABL1 mutations were analyzed by Sanger sequencing.We evaluated 25 chronic myeloid leukemia patients who had been previously treated with imatinib and a second tyrosine kinase inhibitor. Nine patients were switched to dasatinib, and 16 patients were switched to nilotinib as a third-line therapy. Of the chronic phase patients (n=18), 89% achieved a complete hematologic response, 13% achieved a complete cytogenetic response and 24% achieved a major molecular response. The following BCR-ABL1 mutations were detected in 6/14 (43%) chronic phase patients: E255V, Y253H, M244V, F317L (2) and F359V. M351T mutation was found in one patient in the accelerated phase of the disease. The five-year overall, progression-free and event-free survivals were 86, 54 and 22% (p<0.0001), respectively, for chronic phase patients and 66%, 66% and 0% (p<0.0001), respectively, for accelerated phase patients. All blast crisis patients died within 6 months of treatment. Fifty-six percent of the chronic phase patients lost their hematologic response within a median of 23 months.Although the responses achieved by the third tyrosine kinase inhibitor were not sustainable, a third tyrosine kinase inhibitor may be an option for improving patient status until a donor becomes available for transplant. Because the long-term outcome for these patients is poor, the development of new therapies for resistant chronic myeloid leukemia patients is necessary.

Dataset Information

Two-Stage Primary Arthroplasty of Native Hips and Knees That Had Previously Failed Treatment for Septic Arthritis: A Single-Center Experience.

Publications

Two-Stage Primary Arthroplasty of Native Hips and Knees That Had Previously Failed Treatment for Septic Arthritis: A Single-Center Experience.

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