Two-Stage Exchange Hip Arthroplasty: Articulating Spacers

  • Glenn J. Kerr
  • Matthew S. Austin


The incidence of primary total hip arthroplasty (THA) is estimated to increase 174 % to 552,000 procedures by the year 2030 and the demand for revision hip surgery may double by 2026 (J Bone Joint Surg Am 89(4):780–5, 2007). Periprosthetic joint infections (PJI) are estimated to occur in 1 % of primary THA and 4 % of revision THA procedures (J Bone Joint Surg Am 87(7):1487–97, 2005; Clin Orthop Relat Res 468(1):52–6, 2010). Thus, it can be extrapolated that the treatment of PJI will become much more common in the future (J Arthroplasty 5(8):1216–22e1-3, 2010). Once diagnosed, a chronic deep infection can be treated by one of several methods. Chronic suppression, irrigation and debridement, single-stage exchange, and two-stage exchange have all been described in the treatment of PJI (Clin Orthop Relat Res 369:139–43, 1999; J Bone Joint Surg Am 65(1):128–34, 1983; Orthop Clin North Am 24(4):761–7, 1993; J Arthroplasty 3(2):109–16, 1988; Clin Orthop Relat Res 414:55–60, 2003; J Bone Joint Surg Br. 1981;63-B(3):342–53; Clin Orthop Relat Res 211:103–7, 1986). Two-stage exchange is the generally accepted standard-of-care in North America (J Arthroplasty 19(6):768–74, 2004; J Arthroplasty 20(7):874–9, 2005; Clin Orthop Relat Res 2005;441:243–9; J Arthroplasty 2009;24(8):1264–9; J Arthroplasty 2007;22(1):72–8; Clin Orthop Relat Res 2009;467(1):219–24; J Bone Joint Surg Am 2011;93(7):631–9; J Bone Joint Surg Am 1998;80(1):60–9).


Periprosthetic Joint Infection Extended Trochanteric Osteotomy Reimplantation Surgery Antibiotic Load Follow Revision Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Extended trochanteric osteotomy


Methicillin-resistant Staphy-lococcus aureus


Musculoskeletal Infection Society


Methicillin sensitive Staphy-lococcus aureus


Periprosthetic joint infection


Prosthesis of antibiotic loaded cement


Total hip arthroplasty


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Thomas Jefferson University Hospital, Rothman Institute OrthopedicsPhiladelphiaUSA

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