PURPOSE: Prosthetic hip joint infection remains a challenging socio-economic problem. Curative treatment is usually a one- or two-stage revision surgery, but neither of these options has yet emerged as the treatment of choice. The aim of this study was to evaluate which of these methods produced superior outcomes. METHODS: A retrospective study was performed including 92 patients with deep infections after implantation of primary total hip arthroplasty (THA) who had undergone either one-stage or two-stage revision surgery at a single centre. Infections were classified according to McPherson and we evaluated the rate of persisting infection or reinfection after surgical intervention. RESULTS: The two-stage revision surgery revealed superior outcomes for the analysed infection categories compared to the one-stage procedure except for the least serious category of infections (i.e. McPherson Stage I/A/1, early postoperative infection, no systemic comorbidities, local status uncompromised). Eradication of prosthetic infection was achieved in 94.5 % (n = 52) within the group of two-stage exchange, and 56.8 % (n = 21) of patients treated with a one-stage procedure. Outcome of patients following a one-stage or a two-stage exchange was overall significantly different with p < 0.001. Further deviations between the described two procedures were noted in the subgroups following the classification described by McPherson. CONCLUSIONS: Our results indicate superiority of two-stage revision surgery in case of serious infections. The authors believe that decisions on the surgical approach for the treatment of deep prosthesis infections should be made on the basis of standardized staging systems.
PURPOSE: Prosthetic hip joint infection remains a challenging socio-economic problem. Curative treatment is usually a one- or two-stage revision surgery, but neither of these options has yet emerged as the treatment of choice. The aim of this study was to evaluate which of these methods produced superior outcomes. METHODS: A retrospective study was performed including 92 patients with deep infections after implantation of primary total hip arthroplasty (THA) who had undergone either one-stage or two-stage revision surgery at a single centre. Infections were classified according to McPherson and we evaluated the rate of persisting infection or reinfection after surgical intervention. RESULTS: The two-stage revision surgery revealed superior outcomes for the analysed infection categories compared to the one-stage procedure except for the least serious category of infections (i.e. McPherson Stage I/A/1, early postoperative infection, no systemic comorbidities, local status uncompromised). Eradication of prosthetic infection was achieved in 94.5 % (n = 52) within the group of two-stage exchange, and 56.8 % (n = 21) of patients treated with a one-stage procedure. Outcome of patients following a one-stage or a two-stage exchange was overall significantly different with p < 0.001. Further deviations between the described two procedures were noted in the subgroups following the classification described by McPherson. CONCLUSIONS: Our results indicate superiority of two-stage revision surgery in case of serious infections. The authors believe that decisions on the surgical approach for the treatment of deep prosthesis infections should be made on the basis of standardized staging systems.
Authors: Hany Bedair; Nicholas Ting; Kevin J Bozic; Craig J Della Valle; Scott M Sporer Journal: Clin Orthop Relat Res Date: 2011-10-14 Impact factor: 4.176
Authors: Christopher F Wolf; Ning Yan Gu; Jason N Doctor; Paul A Manner; Seth S Leopold Journal: J Bone Joint Surg Am Date: 2011-04-06 Impact factor: 5.284
Authors: Georgios K Triantafyllopoulos; Lazaros A Poultsides; Vasileios I Sakellariou; Wei Zhang; Peter K Sculco; Yan Ma; Thomas P Sculco Journal: Int Orthop Date: 2015-03-31 Impact factor: 3.075
Authors: Elzaan Booysen; Hanél Sadie-Van Gijsen; Shelly M Deane; William Ferris; Leon M T Dicks Journal: Probiotics Antimicrob Proteins Date: 2019-09 Impact factor: 4.609
Authors: Thomas Ilchmann; Werner Zimmerli; Peter Emil Ochsner; Bernhard Kessler; Lukas Zwicky; Peter Graber; Martin Clauss Journal: Int Orthop Date: 2015-07-30 Impact factor: 3.075