Development of evidence-based guidelines for the treatment and management of periprosthetic hip infection: The inform guidelines

Moore, Andrew J.; Wylde, Vikki; Whitehouse, Michael R.; Beswick, Andrew D.; Walsh, Nicola E.; Jameson, Catherine; Blom, Ashley W.

Abstract

Aims Periprosthetic hip-joint infection is a multifaceted and highly detrimental outcome for patients and clinicians. The incidence of prosthetic joint infection reported within two years of primary hip arthroplasty ranges from 0.8% to 2.1%. Costs of treatment are over five-times greater in people with periprosthetic hip joint infection than in those with no infection. Currently, there are no national evidence-based guidelines for treatment and management of this condition to guide clinical practice or to inform clinical study design. The aim of this study is to develop guidelines based on evidence from the six-year INFection and ORthopaedic Management (INFORM) research programme. Methods We used a consensus process consisting of an evidence review to generate items for the guidelines and online consensus questionnaire and virtual face-to-face consensus meeting to draft the guidelines. Results The consensus panel comprised 21 clinical experts in orthopaedics, primary care, rehabilita-tion, and healthcare commissioning. The final output from the consensus process was a 14-item guideline. The guidelines make recommendations regarding increased vigilance and monitoring of those at increased risk of infection; diagnosis including strategies to ensure the early recognition of prosthetic infection and referral to orthopaedic teams; treatment, including early use of DAIR and revision strategies; and postoperative management including appropriate physical and psychological support and antibiotic strategies. Conclusion We believe the implementation of the INFORM guidelines will inform treatment protocols and clinical pathways to improve the treatment and management of periprosthetic hip infection.

• Journal Article Type: Article
• Acceptance Date: Feb 20, 2023
• Online Publication Date: Apr 1, 2023
• Publication Date: Apr 1, 2023
• Deposit Date: Apr 26, 2023
• Publicly Available Date: Apr 26, 2023
• Journal: Bone and Joint Open
• Electronic ISSN: 2633-1462
• Publisher: British Editorial Society of Bone and Joint Surgery
• Peer Reviewed: Peer Reviewed
• Volume: 4
• Issue: 4
• Pages: 226-233
• DOI: https://doi.org/10.1302/2633-1462.44.BJO-2022-0155.R1
• Keywords: Surgery; Orthopedics and Sports Medicine; periprosthetic hip infection; infection; Bone infection
• Public URL: https://uwe-repository.worktribe.com/output/10625915
• Publisher URL: https://boneandjoint.org.uk/article/10.1302/2633-1462.44.BJO-2022-0155.R1