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HIP; Surgical Technique: Bone Loss and Muscle Insufficiency

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One-Stage Septic Revision Arthroplasty

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Abstract

Periprosthetic joint infection (PJI) is a devastating complication following joint arthroplasty, leading to significant morbidity and healthcare costs. The current gold standard for treatment is the two-stage exchange arthroplasty, which involves the removal of the infected prosthesis, a period of antibiotic therapy, and subsequent re-implantation of a new prosthesis. However, this approach imposes a considerable burden on patients, including multiple surgeries, prolonged hospital stays, and functional limitations.

There is growing evidence suggesting that one-stage exchange arthroplasty may be an equally effective alternative. One-stage exchange involves the removal of the infected prosthesis and foreign material, radical debridement of the affected tissues, and immediate re-implantation of a new prosthesis in a single surgical procedure utilizing targeted antimicrobial therapy.

Advantages of one-stage exchange arthroplasty include reduced patient burden, shorter hospital stays, and earlier return to function. Additionally, this approach is based on the accurate identification of the causative organism enabling targeted antibiotic therapy both systemically and locally. When this is combined with proper surgical technique and appropriate choice of implants, the success rates of one-stage exchange procedures are comparable to the two-stage approach.

Although the literature on one-stage exchange arthroplasty is limited compared to the extensive evidence supporting two-stage exchange, current studies have shown promising outcomes and lower overall morbidity. Nevertheless, large multi-centered randomized controlled trials are needed to compare postoperative outcomes, including infection control rates and functional scores, and to establish definitive guidelines for the management of this complex condition.

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References

  1. Fink B, Makowiak C, Fuerst M, Berger I, Schafer P, Frommelt L. The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg Br. 2008;90:874–8.

    Article  CAS  PubMed  Google Scholar 

  2. Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am. 2005;87:1746–51.

    PubMed  Google Scholar 

  3. Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplast. 2008;23:984–91.

    Article  Google Scholar 

  4. De Man FH, Sendi P, Zimmerli W, Maurer TB, Ochsner PE, Ilchmann T. Infectiological, functional, and radiographic outcome after revision for prosthetic hip infection according to a strict algorithm. Acta Orthop. 2011;82:27–34.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gehrke T, Zahar A, Kendoff D. One-stage exchange: it all began here. Bone Joint J. 2013;95-B(11 Suppl A):77–83.

    Article  CAS  PubMed  Google Scholar 

  6. Romano CL, Manzi G, Logoluso N, Romano D. Value of debridement and irrigation for the treatment of periprosthetic infections. A systematic review. Hip Int. 2012;22(Suppl 8):S19–24.

    Article  PubMed  Google Scholar 

  7. Cierny G III, DiPasquale D. Periprosthetic total joint infections: staging, treatment, and outcomes. Clin Orthop Relat Res. 2002;403:23–8.

    Article  Google Scholar 

  8. Hsieh PH, Shih CH, Chang YH, et al. Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am. 2004;86-A:1989–97.

    Article  Google Scholar 

  9. ICG. International Consensus Group on periprosthetic infection. Consensus statements. Philadelphia: Thomas Jefferson University; 2013.

    Google Scholar 

  10. Parvizi J, Adeli B, Zmistowski B, et al. Management of periprosthetic joint infection: the current knowledge: AAOS exhibit selection. J Bone Joint Surg Am. 2012;94:e104.

    Article  PubMed  Google Scholar 

  11. Zahar A, Webb J, Gehrke T, Kendoff D. One-stage exchange for prosthetic joint infection of the hip. Hip Int. 2015;25:301–7.

    Article  PubMed  Google Scholar 

  12. Haddad FS, Masri BA, Garbuz DS, Duncan CP. The treatment of the infected hip replacement. The complex case. Clin Orthop Relat Res. 1999;369:144–56.

    Article  Google Scholar 

  13. Cooper HJ, Della Valle CJ. The two-stage standard in revision total hip replacement. Bone Joint J. 2013;95-B(11 Suppl A):84–7.

    Article  CAS  PubMed  Google Scholar 

  14. Engesaeter LB, Dale H, Schrama JC, et al. Surgical procedures in the treatment of 784 infected THAs reported to the Norwegian Arthroplasty Register. Acta Orthop. 2011;82:530–7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Buchholz HW, Elson RA, Engelbrecht E, et al. Management of deep infection of total hip replacement. J Bone Joint Surg Br. 1981;63-B:342–53.

    Article  CAS  PubMed  Google Scholar 

  16. Gehrke T, Kendoff D. Peri-prosthetic hip infections: in favour of one-stage. Hip Int. 2012;22(Suppl 8):S40–5.

    Article  PubMed  Google Scholar 

  17. Steinbrink K, Frommelt L. Treatment of periprosthetic infection of the hip using one-stage exchange surgery. Orthopade. 1995;24:335–43. [in German].

    CAS  PubMed  Google Scholar 

  18. Zeller V, Lhotellier L, Marmor S, et al. One-stage exchange arthroplasty for chronic periprosthetic hip infection: results of a large prospective cohort study. J Bone Joint Surg Am. 2014;96:e1.

    Article  PubMed  Google Scholar 

  19. McPherson EJ, Woodson C, Holtom P, et al. Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res. 2002;403:8–15.

    Article  Google Scholar 

  20. Parvizi J, Della Valle CJ. AAOS clinical practice guideline: diagnosis and treatment of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg. 2010;18:771–2.

    Article  PubMed  Google Scholar 

  21. Romano CL, Romano D, Albisetti A, et al. Preformed antibiotic-loaded cement spacers for two-stage revision of infected total hip arthroplasty. Long-term results. Hip Int. 2012;22(Suppl 8):S46–53.

    Article  PubMed  Google Scholar 

  22. Berend KR, Lombardi AV Jr, Morris MJ, et al. Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res. 2013;471:510–8.

    Article  PubMed  Google Scholar 

  23. Loty B, Postel M, Evrard J, et al. One stage revision of infected total hip replacements with replacement of bone loss by allografts. Study of 90 cases of which 46 used bone allografts. Int Orthop. 1992;16:330–8. [in French].

    CAS  PubMed  Google Scholar 

  24. Winkler H, Stoiber A, Kaudela K, et al. One stage uncemented revision of infected total hip replacement using cancellous allograft bone impregnated with antibiotics. J Bone Joint Surg Br. 2008;90:1580–4.

    Article  CAS  PubMed  Google Scholar 

  25. Wroblewski BM. One-stage revision of infected cemented total hip arthroplasty. Clin Orthop Relat Res. 1986;211:103–7.

    Article  Google Scholar 

  26. Jiranek WA, Waligora AC, Hess SR, et al. Surgical treatment of prosthetic joint infections of the hip and knee: changing paradigms? J Arthroplast. 2015;30:912–8.

    Article  Google Scholar 

  27. Lichstein P, Gehrke T, Lombardi A, et al. One-stage vs two-stage exchange. J Arthroplast. 2014;29(Suppl 2):108–11.

    Article  Google Scholar 

  28. Ince A, Rupp J, Frommelt L, et al. Is “aseptic” loosening of the prosthetic cup after total hip replacement due to nonculturable bacterial pathogens in patients with low-grade infection? Clin Infect Dis. 2004;39:1599–603.

    Article  CAS  PubMed  Google Scholar 

  29. Parvizi J, Ghanem E, Menashe S, et al. Periprosthetic infection: what are the diagnostic challenges? J Bone Joint Surg Am. 2006;88(Suppl 4):138–47.

    PubMed  Google Scholar 

  30. Schinsky MF, Della Valle CJ, Sporer SM, et al. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg Am. 2008;90:1869–75.

    Article  PubMed  Google Scholar 

  31. Frommelt L. Principles of systemic antimicrobial therapy in foreign material associated infection in bone tissue, with special focus on periprosthetic infection. Injury. 2006;37(Suppl 2):S87–94.

    Article  PubMed  Google Scholar 

  32. Hanssen AD, Spangehl MJ. Practical applications of antibiotic-loaded bone cement for treatment of infected joint replacements. Clin Orthop Relat Res. 2004;427:79–85.

    Article  Google Scholar 

  33. Raut VV, Siney PD, Wroblewski BM. One-stage revision of infected total hip replacements with discharging sinuses. J Bone Joint Surg Br. 1994;76:721–4.

    Article  CAS  PubMed  Google Scholar 

  34. Krenn V, Morawietz L, Perino G, et al. Revised histopathological consensus classification of joint implant related pathology. Pathol Res Pract. 2014;210:779–86.

    Article  CAS  PubMed  Google Scholar 

  35. Schafer P, Fink B, Sandow D, et al. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis. 2008;47:1403–9.

    Article  PubMed  Google Scholar 

  36. Fink B, Vogt S, Reinsch M, et al. Sufficient release of antibiotic by a spacer 6 weeks after implantation in two-stage revision of infected hip prostheses. Clin Orthop Relat Res. 2011;469:3141–7.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Winkler H, Kaudela K, Stoiber A, et al. Bone grafts impregnated with antibiotics as a tool for treating infected implants in orthopedic surgery - one stage revision results. Cell Tissue Bank. 2006;7:319–23.

    Article  CAS  PubMed  Google Scholar 

  38. Schildhauer TA, Robie B, Muhr G, et al. Bacterial adherence to tantalum versus commonly used orthopedic metallic implant materials. J Orthop Trauma. 2006;20:476–84.

    Article  PubMed  Google Scholar 

  39. Zahar A, Kendoff DO, Klatte TO, et al. Can good infection control be obtained in one-stage exchange of the infected TKA to a rotating hinge design? 10-year results. Clin Orthop Relat Res. 2016;474:81–7.

    Article  PubMed  Google Scholar 

  40. Callaghan JJ, Katz RP, Johnston RC. One-stage revision surgery of the infected hip. A minimum 10-year followup study. Clin Orthop Relat Res. 1999;369:139–43.

    Article  Google Scholar 

  41. Choi HR, Kwon YM, Freiberg AA, et al. Comparison of one-stage revision with antibiotic cement versus two-stage revision results for infected total hip arthroplasty. J Arthroplast. 2013;28(Suppl 8):66–70.

    Article  Google Scholar 

  42. George DA, Konan S, Haddad FS, et al. Single-stage hip and knee exchange for periprosthetic joint infection. J Arthroplast. 2015;30:2264–70.

    Article  Google Scholar 

  43. Hansen E, Tetreault M, Zmistowski B, et al. Outcome of one-stage cementless exchange for acute postoperative periprosthetic hip infection. Clin Orthop Relat Res. 2013;471:3214–22.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Klouche S, Leonard P, Zeller V, et al. Infected total hip arthroplasty revision: one- or two-stage procedure? Orthop Traumatol Surg Res. 2012;98:144–50.

    Article  CAS  PubMed  Google Scholar 

  45. Raut VV, Siney PD, Wroblewski BM. One-stage revision of total hip arthroplasty for deep infection. Long-term follow up. Clin Orthop Relat Res. 1995;321:202–7.

    Google Scholar 

  46. Kilgus DJ, Howe DJ, Strang A. Results of periprosthetic hip and knee infections caused by resistant bacteria. Clin Orthop Relat Res. 2002;404:116–24.

    Article  Google Scholar 

  47. Wongworawat MD. Clinical faceoff: one- versus two-stage exchange arthroplasty for prosthetic joint infections. Clin Orthop Relat Res. 2013;471:1750–3.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Mortazavi SM, O’Neil JT, Zmistowski B, et al. Repeat 2-stage exchange for infected total hip arthroplasty: a viable option? J Arthroplast. 2012;27:923–6.e1.

    Article  Google Scholar 

  49. Mortazavi SM, Vegari D, Ho A, et al. Two stage exchange arthroplasty for infected total knee arthroplasty: predictors of failure. Clin Orthop Relat Res. 2011;469:3049–54.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. St. George University Teaching Hospital, Szekesfehervar, Hungary

    Akos Zahar & Nandor J. Nemes

  2. Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg, Hamburg, Germany

    Christian Lausmann

Authors
  1. Akos Zahar
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  2. Nandor J. Nemes
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  3. Christian Lausmann
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Corresponding author

Correspondence to Akos Zahar .

Editor information

Editors and Affiliations

  1. Dept. of Orthopedic Surgery, Helios Endo-Klinik Hamburg, Hamburg, Germany

    Mustafa Citak

  2. Department of Orthopaedics and Traumatology, Ankara Guven Hospital Cayyolu Health Campus, Ankara, Türkiye

    Mustafa Akkaya

  3. Dept of Orthopedic Surgery, ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany

    Thorsten Gehrke

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Zahar, A., Nemes, N.J., Lausmann, C. (2024). HIP; Surgical Technique: Bone Loss and Muscle Insufficiency. In: Citak, M., Akkaya, M., Gehrke, T. (eds) One-Stage Septic Revision Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-031-59160-0_6

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  • DOI: https://doi.org/10.1007/978-3-031-59160-0_6

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-031-59160-0

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