Changing Surgical Approach During Periprosthetic Joint Infection Treatment Does Not Increase Risk of Eradication Failure: A Multicenter Retrospective Cohort Study

IntroductionHip approach discordance in aseptic revision total hip arthroplasty (THA) is not associated with increased dislocation or re-revision risk.Whether the same holds true for the treatment of periprosthetic joint infection (PJI) is unknown.This study reported the rate of hip approach discordance during PJI treatment, identified associated factors, and tested possible associations with outcomes (septic and aseptic failures). MethodsThis is an ethics-approved, multicenter, consecutive-case series of 517 primary THAs (mean age 65 years (range, 20 to 94), mean body mass index (BMI) 31 (range, 16.7 to 58.7), and 52.6% women treated for PJI.Of these, 431 had minimum one-year follow-up (mean five years (range, one to 17.2)) and were included in the outcome analyses.Most index approaches were posterior (PA: 302, 58.4%), followed by lateral (LA: 111, 21.5%) and anterior (AA: 104, 20.1%).Acute PJI accounted for 37% of cases, with the remaining cases representing chronic infections.Initial treatment across the entire cohort included debridement, antibiotics, and implant retention (DAIR) (61.9%), first-stage revision (30.4%), and single-stage revision (5.4%), reflecting management of both acute and chronic PJI.Outcomes of interest included PJI treatment success (Musculoskeletal Infection Society (MSIS) tiers 1 to 2) and aseptic complications (dislocation, fracture, and aseptic loosening). Results J o u r n a l P r e -p r o o fChange of approach occurred in 23.8% of cases, mostly occurring at the first surgical intervention (19.9%).Approach discordance was more common with AA (62.1%), followed by LA (51%) and PA (0.7%) (P < 0.001), and with first-stage revisions (36.3%) compared to DAIR (17.2%) and single-stage (10.7%) revisions (P < 0.001).There were no patient factors that were associated with approach discordance.Success of PJI treatment by the latest follow-up was 87.2% (376 of 431) and not associated with approach change (P = 0.73).Aseptic complications were seen in 4.4% of cases, with dislocation being most common (2.6%).There was no difference in overall complication or dislocation rates when the approach was changed (P = 0.33 to 0.73). ConclusionComparable outcomes are seen in PJI treatment with concordant and discordant approaches between primary and PJI treatment.This data provides reassurance to surgeons that the change of approach is safe and efficacious in PJI treatment without increased septic or aseptic risks.