One-stage revision of infected hip arthroplasty: outcome of 39 consecutive hips

Ilchmann, Thomas; Zimmerli, Werner; Ochsner, P. E.; Kessler, Bernhard; Zwicky, Lukas; Gräber, Peter; Clauss, Martin

doi:10.1007/s00264-015-2833-4

Cited by 67 publications

(36 citation statements)

References 25 publications

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“…One-stage exchange is suitable for patients who have good bone conditions and soft tissue without sinus tract, as well as known bacteria with no difficult-to-treat (DTT) infections caused by pathogens resistant to biofilm-active antimicrobials42). If based on the indication, the success rate of one-stage exchange could be reach 100%44). In a single center report45), the success rate of one-stage replacement is from 85% to 90% over 35 years.…”

Section: Treatmentmentioning

confidence: 99%

Management of Periprosthetic Joint Infection

2018

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Periprosthetic joint infection (PJI) is a serious complication after arthroplasty, which is associated with pain, prolonged hospital stay, multiple surgeries, functional incapacitation, and even mortality. Using scientific and efficient management protocol including modern diagnosis and treatment of PJI and eradication of infection is possible in a high percentage of affected patients. In this article, we review the current knowledge in epidemiology, classification, pathogenesis, diagnosis and treatment of PJI.

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Section: Treatmentmentioning

confidence: 99%

Management of Periprosthetic Joint Infection

2018

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“…2014, Ilchmann et al. 2016), and there are no data on detailed radiological outcome. In septic revisions, the stability of uncemented stems may be impaired due to reduced ingrowth caused by low bone quality (Ochsner 2011) and also, in 1-stage exchange, by peri-implant osteomyelitis.…”

mentioning

confidence: 99%

Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties

Born¹,

Ilchmann

Zimmerli

et al. 2016

Acta Orthopaedica

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Background and purpose — The use of uncemented revision stems is an established option in 2-stage procedures in patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, in 1-stage procedures, they are still rarely used. There are still no detailed data on radiological outcome after uncemented 1-stage revisions. We assessed (1) the clinical outcome, including reoperation due to persistent infection and any other reoperation, and (2) the radiological outcome after 1- and 2-stage revision, using an uncemented stem.Patients and methods — Between January 1993 and December 2012, an uncemented revision stem was used in 81 THAs revised for PJI. Patients were treated with 1- or 2-stage procedures according to a well-defined algorithm (1-stage: n = 28; 2-stage: n = 53). All hips had a clinical and radiological follow-up. Outcome parameters were eradication of infection, re-revision of the stem, and radiological changes. Survival was calculated using Kaplan-Meier analysis. Radiographs were analyzed for bone restoration and signs of loosening. The mean clinical follow-up time was 7 (2–15) years.Results — The 7-year infection-free survival was 96% (95% CI: 92–100), 100% for 1-stage revision and 94% for 2-stage revision (95% CI: 87–100) (p = 0.2). The 7-year survival for aseptic loosening of the stem was 97% (95% CI: 93–100), 97% for 1-stage revision (95% CI: 90–100) and 97% for 2-stage revision (95% CI: 92–100) (p = 0.3). No further infection or aseptic loosening occurred later than 7 years postoperatively. The radiographic results were similar for 1- and 2-stage procedures.Interpretation — Surgical management of PJI with stratification to 1- or 2-stage exchange according to a well-defined algorithm combined with antibiotic treatment allows the safe use of uncemented revision stems. Eradication of infection can be achieved in most cases, and medium- and long-term results appear to be comparable to those for revisions for aseptic loosening.

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“…Although one-stage exchange has shown promise [5,18,21,23,33], the efficacy of this treatment in cases of chronic infection and resistant organisms and the need for long-term intravenous antibiotic management may limit its use to selected cases. Treatment of both chronically infected cemented THA and late-onset acute infections in well-ingrown cementless THA using a single-stage revision combined with direct catheter infusion of antibiotics into the joint was successful in this small series, both among patients with antibiotic-sensitive and -resistant organisms; no severe complications were attributable to the use the intraarticular antibiotic infusion.…”

Section: Discussionmentioning

confidence: 99%

“…Although cemented revision of infected THA using a two-stage protocol with an interim antibiotic spacer is still standard practice [3,24,33,38], both twostage revision with cementless implants and single-stage revision surgery commonly are reported to be highly successful [5,18,23,33,58]. Two-stage cementless revision has been reported to eliminate signs of infection in 95% of cases [6], and cementless two-stage revision followed by rerevision is reported to achieve control of infection in 98% of cases [29].…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, singlestage revision procedures performed with or without cement fixation also are used [5,33,58], and no clear evidence exists that two-stage revision yields superior results to single-stage protocols [5,14,18,21,23,33,58]. Additionally, the interim antibiotic cement spacers associated with two-stage exchange may carry some risk including dislocation of the spacer [15,26,43], fracture of the hip [15], fracture of the spacer [9,15,26], migration of the spacer leading to bone damage or even vascular injury [48], rare reports of renal injury from antibiotic elution, and the need to remove the spacershould these complications occur [1,10,13,37,40,42,52].…”

Section: Introductionmentioning

confidence: 99%

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One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

Whiteside

Roy

2017

Clinical Orthopaedics &Amp; Related Research

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Background Two-stage revision surgery for infected total hip arthroplasty (THA) is commonly advocated, but substantial morbidity and expense are associated with this technique. In certain cases of infected THA, treatment with one-stage revision surgery and intraarticular infusion of antibiotics may offer a reasonable alternative with the distinct advantage of providing a means of delivering the drug in high concentrations. Questions/purposes We describe a protocol for intraarticular delivery of antibiotics to the hip through an indwelling catheter combined with one-stage revision surgery and examine (1) the success as judged by eradication of infection at 1 year when treating chronically infected cemented stems; (2) success in treating late-onset acute infections in well-ingrown cementless stems; and (3) what complications were associated with this approach in a small case series. Methods Between

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One-stage revision of infected hip arthroplasty: outcome of 39 consecutive hips

Cited by 67 publications

References 25 publications

Management of Periprosthetic Joint Infection

Management of Periprosthetic Joint Infection

Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties

One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

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