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Joint Bone Spine
Volume 86, n° 3
pages 369-372 (mai 2019)
Doi : 10.1016/j.jbspin.2019.01.017
accepted : 13 December 2018
Original Articles

Curative treatment of prosthetic joint infection in patients younger than 80 vs. 80 or older
 

Chloé Jamakorzyan a, b, , Vanina Meyssonnier a, b, Younes Kerroumi a, Benoit Villain a, d, Beate Heym a, c, Luc Lhotellier a, d, Valérie Zeller a, b, Jean-Marc Ziza a, b, Simon Marmor a, d
a Centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, Paris 75020, France 
b Service de médecine interne et rhumatologie, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, Paris 75020, France 
c Laboratoire des centres de santé et hôpitaux d'Ile-de-France, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, Paris 75020, France 
d Service de chirurgie osseuse et traumatologique, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, Paris 75020, France 

Corresponding author at: Centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.Centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon125, rue d'AvronParis75020France
Highlights

The bacterial epidemiology of prosthetic joint infections in patients aged 80 years or over differs from that in younger patients.
One-stage exchange arthroplasty is the treatment of choice in all age groups and provides greater than 90% survival in older patients when performed after a pre-operative evaluation of the appropriateness of curative surgery by a multidisciplinary team.

The full text of this article is available in PDF format.
Abstract
Objective

Prosthetic joint infection (PJI) is a serious complication of joint replacement surgery. The major pharmacological and surgical treatments required by PJI increase the risk of peri-operative complications in elderly patients. The increase in life expectancy combined with procedural advances make these treatments possible even in the oldest patients. Here, our objective was to compare the characteristics and outcomes of curative PJI treatment in patients < 80 years vs. ≥ 80 years.

Methods

A prospective single-center design was used to compare the characteristics and outcomes of curative treatment for hip or knee PJI in patients < 80 years and ≥ 80 years admitted in 2004–2014.

Results

Of 765 patients admitted for PJI, 590 were < 80 years and 124 were ≥ 80 years. Medical history and comorbidities were similar in the two groups. The older group had a significantly higher proportion of patients with American Society of Anesthesiologists Scores ≥ 3 and with streptococcal infection (20% vs. 13%, P  < 0.05). After complete surgical excision and prolonged antibiotic therapy, the only event whose frequency differed significantly between the two groups was PJI-related death, which was more common in the older patients (6.5% vs. 0.8%, P  < 0.05). The 2-year survival rate after one-stage exchange arthroplasty was > 90% in the  ≥80 year group.

Conclusion

Patients aged 80 years or older are eligible for the same curative pharmacological and surgical PJI treatments used in their younger counterparts. Before surgery, the risk/benefit ratio of the major surgical procedure required to treat PJI must be assessed on a case-by-case basis.

The full text of this article is available in PDF format.

Keywords : Arthroplasty, Prosthetic joint infection, Elderly, Octogenarians, Curative surgery, One-stage exchange arthroplasty




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