Two-stage Revision of Implant-associated Infections After Total Hip and Knee Arthroplasty

Overview

Journal GMS Krankenhhyg Interdiszip

Specialty Health Services

Date 2012 Jan 14

PMID 22242098

Citations 15

Authors

Martin Ellenrieder

Robert Lenz

Maximilian Haenle

Rainer Bader

Wolfram Mittelmeier

Affiliations

Soon will be listed here.

Abstract

Septic loosening of total hip and knee endoprostheses gains an increasing proportion of revision arthroplasties. Operative revisions of infected endoprostheses are mentally and physically wearing for the patient, challenging for the surgeon and a significant economic burden for healthcare systems. In cases of early infection within the first three weeks after implantation a one-stage revision with leaving the implant in place is widely accepted. The recommendations for the management of late infections vary by far. One-stage revisions as well as two-stage or multiple revision schedules have been reported to be successful in over 90% of all cases for certain patient collectives. But implant associated infection still remains a severe complication. Moreover, the management of late endoprosthetic infection requires specific logistics, sufficient and standardized treatment protocol, qualified manpower as well as an efficient quality management. With regard to the literature and experience of specialized orthopaedic surgeons from several university and regional hospitals we modified a commonly used treatment protocol for two-stage revision of infected total hip and knee endoprostheses. In addition to the achievement of maximum survival rate of the revision implants an optimisation of the functional outcome of the affected artificial joint is aimed for.

Citing Articles

Serum procalcitonin has no significance in the diagnosis of periprosthesis joint infection before total hip and knee replacement.

Sun X, Zhang H, Liu Y, Lai Z, Zeng Y Front Surg. 2023; 10:1216103.

PMID: 38026480 PMC: 10657873. DOI: 10.3389/fsurg.2023.1216103.

Metal Artefact Reduction Sequences (MARS) in Magnetic Resonance Imaging (MRI) after Total Hip Arthroplasty (THA) : A non-invasive approach for preoperative differentiation between periprosthetic joint infection (PJI) and aseptic complications?.

Busch A, Jager M, Beck S, Wegner A, Portegys E, Wassenaar D BMC Musculoskelet Disord. 2022; 23(1):620.

PMID: 35764987 PMC: 9238049. DOI: 10.1186/s12891-022-05560-x.

Severe polymicrobial and fungal periprosthetic osteomyelitis persisting after hip disarticulations treated with caspofungin in risk patients: a case series.

Enz A, Muller S, Mittelmeier W, Klinder A Ann Clin Microbiol Antimicrob. 2022; 20(1):86.

PMID: 34972536 PMC: 8720203. DOI: 10.1186/s12941-021-00490-3.

[Individual megaspacers in two-stage revision of infected total hip arthroplasty-clinical and functional results after 2 years : Individual metal-endoskeleton cement spacer (iMECS)].

Ellenrieder M, Surmann B, Enz A, Toch S, Lenz R, Mittelmeier W Orthopadie (Heidelb). 2021; 51(7):564-572.

PMID: 34718833 PMC: 8556826. DOI: 10.1007/s00132-021-04185-7.

Evaluation of the standard procedure for treatment of periprosthetic joint infections of total knee and hip arthroplasty: a comparison of the 2015 and 2020 census in total joint replacement centres in Germany.

Osmanski-Zenk K, Klinder A, Rimke C, Wirtz D, Lohmann C, Haas H BMC Musculoskelet Disord. 2021; 22(1):791.

PMID: 34525989 PMC: 8444384. DOI: 10.1186/s12891-021-04661-3.

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