Single- or Two-stage Revision for Infected Total Hip Arthroplasty? A Systematic Review of the Literature

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

“…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.…”

“…An established technique for the treatment of chronic infection in THA is generally considered to consist of two-stage revision with an interim antibiotic-loaded polymethylmethacrylate spacer to deliver antibiotics to the local area combined with intravenous antibiotics to deliver antibiotics systemically [3,24,33,38]. 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].…”

“…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].…”

CORR Insights®: One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

“…As there are no studies directly comparing the success rate of one-versus two-stage exchange arthroplasty [7], there is a need to conduct randomized controlled trials comparing one-to two-stage exchange arthroplasty in similar patient populations.…”

“…Patients treated with one-stage exchange arthroplasty demonstrated high functional outcome scores, high success of infection eradication, and cost savings for undergoing only one surgical procedure in specific patient populations [6,9]. While two-stage exchange arthroplasty for treating PJI has been widely reported, fewer studies report the results of one-stage exchange arthroplasty, and the success rate of surgery is variable [7,8].…”