Which Patients with Chronic Periprosthetic Joint Infection Are Less Suitable to Successful Two Stage Exchange Arthroplasty Surgery? A Retrospective Clinical Trial
, Gabriele Di Carlo 1,2, Davide Pederiva 1,2, Valentino Rossomando 1,2, Federico Pilla 1,2, Matteo Brunello 1,2, Claudio D’Agostino 1,2, Leonardo Tassinari 1,2, Eleonora Zamparini 3 and Cesare Faldini 1,2Round 1
Reviewer 1 Report
The manuscript is retrospective study aimed to highlight potential risk factors of patient with chronic PJIs after THA managed by implant removal, outlining the differences between reimplanted patients and those that were never reimplanted because of a non-eradicated infection. Authors retrospectively reviewed patients affected by chronic PJIs after THA, managed at the Authors’ Institution in a four-year timeframe; data were retrieved by the hospital informatic database. The enrolled population was divided into two Groups (A, reimplanted; B, non-reimplanted because of a non-eradicated infection within 1 year). For each Group demographic, PJI related risk factors, type of pathogen and presence of single or polymicrobial infection, were collected and analyzed.
I read the article with interest; in the title it would be appropriate to refer that it is a retrospective study.
A) The abstract is sufficiently developed, but a few concerns are present:
Comment 1 Clear reference should be made to the characteristics of the study.
B) In the introduction, the characteristics of the periprosthetic hip infections have been accurately described, even if a little too synthetic.
Comment 2: Some references should be added regarding the diagnosis, treatment, and prognosis that can occur after this type of fracture, for example: (Bureau A, et al (2022) "Management of Periprosthetic Joint Infections After Hemiarthroplasty of the Hip: A Critical Analysis Review")
Comment 3: “It is based on two separate surgeries: the first is a resection arthroplasty in which the implant is removed, and an extensive debridement is performed. After surgery, systemic antimicrobials are administered, accordingly to sensitivity profile of the isolated microorganism, or empirically when no pathogen is identified.” Please, add some bibliographic references.
C) In materials and methods, the evaluation methods have been adequately developed.
Comment 4: It would be appropriate to refer to the inclusion criteria in the study.
Comment 5: By which operator was the surgical treatment performed? Was it the same operator for each type of operation?
Comment 6: Have they undergone postoperative physiotherapy treatment?
Comment 7: How long after the diagnosis of infection were they treated?
D) The discussion is sufficiently developed, even if a little too synthetic.
Finally, English language editing is needed.
Nevertheless, some minor changes are needed to be considered suitable for publication.
Author Response
corrected as requested
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Dear Authors,
I read your manuscript with interest and appreciation. Below are some remarks that I hope will improve the paper.
1. Material and methods do not contain any data concerning how periprosthetic joint infection was diagnosed. Were there any local changes and in laboratory tests?
2. How was the first stage (endoprosthesis removal) performed? Did you use any spacer, collagen sponge with antibiotics? Were the patients in both groups treated in the same way?
3. Which antibiotic and for how long was used after the surgery? Were there any changes between both groups?
4. How were patients qualified for second stage (reimplantation) – improvement and normalization of inflammatory markers (CRP?), the absence of local changes? The comparison of group A and B should be made.
Author Response
corrected as requested
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
In my opinion the manuscript has been sufficiently improved to warrant publication in Clinics and Practice.
