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Master Thesis

Événements indésirables sévères au cours de la prise en charge médico-chirurgicale des infections de prothèses de hanche et de genou

Abstract : Introduction: the treatment of infections following hip (THA) and knee prosthesis (TKA) by changing the implant in one or two stages with antibiotic therapy is a complex procedure that can be associated with complications. However, the occurrence of severe adverse events (SAEs) and their associated risk factor during this treatment has been little evaluated. Objective: the objective of our study was the description of SAEs in the medico-surgical management of hip and knee infections (PJI), and the identification of risk factors associated with their occurrence. Patients and methods: a retrospective study including patients treated for THA or TKA infection in a reference center for osteoarticular infections (CRIOA) with 1 or 2-stage implant replacement. The objective was to describe Grade ≥ 3 SAEs that occurred within 6 weeks of the start of surgical management of the infection (CTCAE classification, grade 3: Significant event without a life-threatening condition, grade 4; life-threatening, grade 5: death). Results: one hundred and eighteen patients were identified between January 1, 2013 and December 31, 2017. The average age was 71 years (range: 43-90 years) and 66 patients were male (55.9 %). Seventy-three patients (61.9 %) had THA infection and 45 (38.1 %) had TKA infection. Patients had the following comorbidities: heart disease (n = 47, of which 18 patients on VKA and 6 on DOACs), immunodeficiency or history of neoplasia (n = 37), diabetes (n = 18), obesity (n = 16) or chronic kidney insufficiency (n = 8). We observed 191 all-grade adverse events, including 71 SAE in 50 patients (42.3 %). Sixteen SAEs had an evolution of the infection. The remaining 55 SAEs occurred in 41 patients (34.7 %). This consisted of 47 SAE grade 3 and 8 SAE grade 4. These 55 SAEs were distributed as follows: 17 bleedings requiring transfusion, 9 cardiopulmonary, 7 antibiotic-related, 8 infectious, unrelated to osteoarticular infection, 5 acute renal failures and / or ionic disorders, 4 mechanical surgical complications, 4 neurological or digestive SAE and 1 hematologic SAE. The risk factors identified were two-stage management, with OR 4.27 95% CI [1.31-13.92], p = 0.016 and obesity with OR 3.49 CI 95 % [1.01-11.98], p = 0.047. Conclusion: the occurrence of SAE is frequent within 6 weeks following a change of joint prosthesis for infection and is related to the frequency of comorbidities in this population. The risk factors significantly associated with these SAEs are obesity and prosthetic change in two stages.
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Master Thesis
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Sarah Perez. Événements indésirables sévères au cours de la prise en charge médico-chirurgicale des infections de prothèses de hanche et de genou. Médecine humaine et pathologie. 2019. ⟨dumas-02495997⟩

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