Effect of a multidisciplinary team on the treatment of hip and knee prosthetic joint infections: a single-centre study of 154 infections

Figures & data

Table 1. The differences in the three study groups.

	Group 1	Group 2	Group 3
Time period of index operation	1 January 2005 to 31 December 2007	1 January 2011 to 31 December 2013	1 January 2015 to 31 December 2016
Number of PJIs*	21	65	68
Changes in the treatment of PJI*	Arthroplasties and PJI treatment in three hospitals	Arthroplasties and PJI treatment centralized in one hospital Multidisciplinary team responsible for PJI treatment Orthopaedic surgeon specialized in arthroplasty surgery responsible for all PJI operations	Arthroplasties and PJI treatment centralised in one hospital Multidisciplinary team responsible for PJI treatment Orthopaedic surgeon specialized in arthroplasty surgery responsible for all PJI operations Implant sonication introduced in late 2013 Dedicated microbial sampling instrumentation according to the Oxford, UK, Bone Infection Unit tissue sampling protocol introduced in 2015

*Prosthetic joint infection.

Table 2. Demographics of the prosthetic joint infection cases.

	Group 1 (n = 21) (2005–2007)	Group 2 (n = 65) (2011–2013)	Group 3 (n = 68) (2015–2016)
	n (%)	n (%)	n (%)
Age at diagnosis of PJI* (median, Q1–Q3, years)	64.0 (58.5–72.5)	67.0 (59.0–76.0)	69.0 (60.0–77.5)
Gender (male)	10 (47.6)	37 (56.9)	39 (57.4)
BMI (median, Q1–Q3)	31.2 (27.2–34.2)	28.5 (25.5–33.0)	28.1 (24.6–34.1)
No comorbidities	2 (9.5)	7 (10.8)	9 (13.2)
More than 3 comorbidities	6 (28.6)	28 (43.1)	22 (32.4)
Index operation type (primary)**	12 (57.1)	41 (63.1)	42 (61.8)
Infected joint (knee)***	13 (67.9)	20 (30.8)	20 (29.4)
Acute postoperative PJI (0–3 months)****	17 (81.0)	59 (90.8)	66 (97.1)
Follow-up time (median, Q1–Q3, months)	127.0 (53.5–142.5)	62.0 (55.5–71.0)	53.0 (46.3–62.0)

*Prosthetic joint infection.

**Index operation primary or revision. Result for primary shown.

***Infected joint knee or hip. Result for knee shown.

****Infection acute (0–3 months) or delayed (3–24 months) postoperatively. Result for acute postoperative shown.

Table 3. Numbers and outcomes of surgical treatment of prosthetic joint infections.

	Group 1 (n = 21) (2005–2007)	Group 2 (n = 65) (2011–2013)	Group 3 (n = 68) (2015–2016)	p Value
Number of	n (%)	n (%)	n (%)
PJI* cases treated with DAIR** as primary surgical treatment	9 (42.9)	53 (81.5)	61 (89.7)	.000
PJI cases treated with DAIR, modular parts exchanged	7 (77.8)	48 (90.6)	58 (95.1)	.187
PJI cases treated with one-stage exchange (all primary surgical treatments)	1 (4.8)	0 (0)	2 (2.9)	.285
PJI cases treated with two-stage exchange	11 (52.4)	20 (30.8)	11 (16.2)	.004
PJI cases treated with two-stage exchange as primary surgical treatment	9 (81.8)	9 (45.0)	5 (45.5)	.000
PJI cases treated with resection arthroplasty, amputation or other operation	5 (23.8)	7 (10.8)	4 (5.9)	.062
PJI cases treated with resection arthroplasty, amputation or other as primary surgical treatment	2 (40.0)	3 (42.9)	0 (0)	.071
Operations (median, Q1-Q3)	2.0 (1.0–3.0)	1.0 (1.0–2.5)	1.0 (1.0–2.0)	.023
Successful outcome of
PJI cases treated with DAIR as primary surgical treatment	5 (55.6)	39 (73.6)	52 (85.2)	.077
PJI cases treated with DAIR, modular parts exchanged	4 (57.1)	35 (72.9)	50 (86.2)	.088
PJI cases treated with one-stage exchange (all primary surgical treatments)	1 (100)	0 (0)	2 (100)	Undefined
PJI cases treated with two-stage exchange	9 (81.8)	17 (85.0)	9 (81.8)	.963
PJI cases treated with two-stage exchange as primary surgical treatment	8 (88.9)	8 (88.9)	4 (80.0)	.873
PJI cases treated with DAIR, one-stage or two-stage exchange as primary surgical treatment, combined	14 (73.7)	47 (75.8)	58 (85.3)	.311

*Prosthetic joint infection.

**Debridement, antibiotics, and implant retention. Successful outcome (DAIR): retaining original implant and no death due to infection.

Successful outcome (one-stage and two-stage exchange): Retaining revised implant and no death due to infection.