Partial implant retention in two-stage exchange for chronic infected total hip arthroplasty

Shi, Xiaojun; Yang, Jing; Zhou, Zongke; Shen, Bin; Kang, Pengde; Pei, Fuxing

doi:10.1007/s00264-019-04473-0

Cited by 4 publications

(7 citation statements)

References 44 publications

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“…The treatment of PJI is complex including surgery and prolonged antibiotic therapy [14,15]. After surgery, antibiotics are given intravenously for one to three weeks continuing orally for additional ten weeks.…”

Section: Introductionmentioning

confidence: 99%

Evaluation and interpretation of prosthetic joint infection diagnostic investigations

Trebše

Roškar

2021

International Orthopaedics (SICOT)

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Background Total joint arthroplasty (TJA) is considered one of the most successful surgical procedures ever developed. It can successfully provide pain relief, restore joint function, and improve mobility and quality of life. Prosthetic joint infection (PJI) presents with a wide variety and severity of signs and symptoms. It remains a major threat to the outcome of TJA procedures and usually necessitates surgical intervention and prolonged courses of antibiotics. Inappropriate treatment of an unrecognized PJI usually ends with unacceptable and sometimes catastrophic results. The aim The understanding and evaluation of diagnostic investigations are extremely important to properly diagnose PJI, including frequently unrecognized low-grade infections, and to provide healthcare professionals with needed information for the care of patients affected by this condition. This article aims to review most of the methods available in PJI diagnostics, to emphasize the strengths and the weaknesses of each of them, and to provide a guideline on how to select the surgical treatment strategy based on the level of diagnostic certainty during the evaluation period. To safely accomplish this, it is crucial to be aware of the limitations of each diagnostic modality. The focus The emphasis will be on the use and interpretation of the core criteria for PJI diagnosis, including the pathognomonic sinus tract communicating with the implant, purulent synovial fluid, inflammation in the periprosthetic tissue, cell count with differential, microbial growth in the synovial fluid culture, tissue sample cultures, and sonication samples.

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Section: Introductionmentioning

confidence: 99%

Evaluation and interpretation of prosthetic joint infection diagnostic investigations

Trebše

Roškar

2021

International Orthopaedics (SICOT)

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“…Once the second stage was complete, we prescribed systematic IV antibiotic therapy for five days until the cultures results were available, as reported by Shi et al [ 34 ]. Unfortunately, there is no standard practice in partial replacement.…”

Section: Discussionmentioning

confidence: 99%

“…Although in previous studies osseointegration of the stem was evaluated solely by the use of imaging techniques [ 2 , 34 ], we strongly advocate for intraoperative testing. We must bear in mind that, unfortunately, there is no standardized imaging protocol for definitely diagnosing femoral stem loosening [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…As opposed to previous studies [ 2 , 20 , 34 ], we performed this technique with a known resistant bacteria infection (e.g., MRSA), which is a common cause of failure of revision replacement surgery [ 36 ]. We believe that the main cause for failure is not exclusively dependent on the type of replacement performed (total or partial), but intrinsic and extrinsic patient factors.…”

Section: Discussionmentioning

confidence: 99%

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Partial Two-Stage Exchange for Infected Total Hip Arthroplasty: A Treatment to Take into Account

Moreno-Romero

Ordas-Bayon

Gomez-Rice

et al. 2023

JPM

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Introduction: Two-stage revision is the gold standard for chronic periprosthetic joint infection (PJI). The removal of well-fixed implants, especially the femoral component, can be extremely difficult and additional osteotomies may be needed, which is time-consuming and results in bone stock loss. When the femoral stem is osseointegrated, there is no clear indication for the use of partial two-stage revision. The primary objective was to assess infection eradication after surgery. Methods: Retrospective study of specific case series. A total of eight patients with a chronic uncemented PJI, in the setting of complex revision surgeries, were treated with partial two-stage revision, which included selective retention of the well-fixed femoral component and complete acetabular removal. Stem retention was carried out regardless of the bacteria or associated comorbidities. Results: All patients were re-revision cases with at least two previous surgeries (range, 2–4). Complex revisions were performed in five cases (non-articulated spacer) and simple revisions in three cases (articulated spacer). The minimum follow-up time was 24 months (range, 24–132 months). The infection eradication rate at final follow-up was 100%. Conclusion: Partial two-stage reconstruction is a promising technique for the treatment of chronic PJI in patients with a well-fixed stem and complex re-revision acetabular procedures. Further prospective studies and prolonged follow-ups are required to confirm our results.

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“…Compared with TTE, PTE is only indicated for a narrow subset of patients with PJI; however, no consensus has been reached regarding selection criteria for this procedure (Table 4 ) [ 6 , 7 , 9 – 11 , 23 – 26 ]. Based on the data presented here, as well as the data from previous studies, we propose that the stricter eligibility criteria should be used for PTE revision for hip PJI [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Partial two-stage exchange: an alternative method for infected total hip arthroplasty

Yishake

Tang

Chen

et al. 2021

BMC Musculoskelet Disord

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Background Total two-stage exchange is commonly used in clinical practice as a treatment for infected total hip arthroplasty (THA); however, this approach involves considerable limitations, including significant bone loss and severe trauma. This retrospective cohort study was conducted to evaluate clinical outcomes following the use of partial two-stage exchange (PTE) for infected THA. Methods We performed a retrospective analysis of 28 patients with infected THA who were treated by PTE between September 2000 and June 2019. Eligibility for PTE was limited to patients with a well-fixed femoral stem prosthesis. In the first stage of the operation, the femoral stem prosthesis was preserved; subsequently, the acetabular prosthesis, liner, and head were replaced with an antibiotic-loaded spacer. The new prosthesis was then implanted into patients and monitored for at least 3 months to ensure freedom from infection. Results Patients were followed for an average of 4 years (range, 2–11 years), with an overall success rate of 85.7% (24/28). The mean Harris hip score at the final follow-up was 76.2 ± 11.7 points. Conclusions The findings of this study suggest that PTE could be an acceptable option for a subset of patients with infected THA, offering a satisfactory infection control rate and clinical outcomes comparable to those of total two-stage exchange, but with less harm.

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Partial implant retention in two-stage exchange for chronic infected total hip arthroplasty

Cited by 4 publications

References 44 publications

Evaluation and interpretation of prosthetic joint infection diagnostic investigations

Evaluation and interpretation of prosthetic joint infection diagnostic investigations

Partial Two-Stage Exchange for Infected Total Hip Arthroplasty: A Treatment to Take into Account

Partial two-stage exchange: an alternative method for infected total hip arthroplasty

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