Two-stage revision of prosthetic hip joint infections using antibiotic-loaded cement spacers: When is the best time to perform the second stage?
- 878 Downloads
Managing periprosthetic joint infections remains a challenging task, and adequate treatment strategies seem to be mandatory to avoid irreversible damage of the affected joint and/or systemic complications. Two-stage revision arthroplasty includes removing all implants and subsequent implantation of an antibiotic-loaded cement spacer, followed by revision arthroplasty as the second stage. Although this procedure is well described in the literature, results remain unpredictable due to various clinical findings and the absence of prospective randomised trials. We analysed (1) mortality and (2) reinfection rates in a series of patients who underwent two-stage revision surgery for periprosthetic hip joint infections with antibiotic-augmented joint spacers. We maintained a special focus on the spacer retention period and its influence on outcome in order to determine the best time for second-stage surgery.
Patients and methods
A consecutive series of 76 patients with native and periprosthetic hip joint infections and who underwent two-stage revision surgery with antibiotic-loaded cement spacers were studied between 2005 and 2010. The second-stage operation was performed when it was assumed that infection was eradicated. The further operative procedure depended upon intra-operative findings (frozen section, local status).
Mean implant-free period with the antibiotic-loaded spacer in situ was 12.6 weeks. Spacer re-implantation was necessary in 13 cases due to positive signs of acute infection in the frozen section and suspect intra-operative findings. Eight patients were not operated for a second time in the investigated time period due to poor general condition. In 40 patients, the spacer retention period was four to 11 weeks: <four weeks for five and >11 weeks for 23. We observed a significantly higher proportion of women free from reinfection in the four to 11-week group than in patients with the shorter or longer period.
According to our findings, the optimal timing for second-stage surgery as a second-stage procedure is between four and 11 weeks. A significantly optimal reinfection rate was seen in patients undergoing revision arthroplasty within that time frame, and 90 % of those patients remained infection free until final follow-up.
KeywordsPeriprosthetic hip joint infection Antibiotic-augmented spacer Two-stage revision procedure
- 5.McPherson, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M (2002) Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res (403):8–15Google Scholar
- 6.Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG (2011) New definition for periprosthetic joint infection-from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 469:2992–2994PubMedCentralCrossRefPubMedGoogle Scholar
- 10.Langlais F (2003) Can we improve the resultsof revision arthroplasty for infected total hipreplacement? J Bone Joint Surg (Br) 85:637–640Google Scholar
- 12.Hothorn T maxstat: Maximally Selected Rank Statistics. R package version 0.7-18, 02 Sep 2013 (available from http://cran.r-project.org/web/packages/maxstat/)
- 16.Wolf M, Clar H, Friesenbichler J, Schwantzer G, Bernhardt G, Gruber G, Glehr M, Leithner A, Sadoghi P (2014) Prosthetic joint infection following total hip replacement: results of one-stage versus two-stage exchange. Int Orthop 38(7):1363–1368. doi: 10.1007/s00264-014-2309-y PubMedCentralCrossRefPubMedGoogle Scholar