Download PDF
J Knee Surg 2014; 27(04): 273-278
DOI: 10.1055/s-0034-1376882
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Management of Periprosthetic Joint Infection: One-Stage Exchange

Daniel Kendoff
1   Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Germany
,
Thorsten Gehrke
1   Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

09 January 2014

02 April 2014

Publication Date:
22 May 2014 (online)

    Permissions and Reprints

Abstract

Although it does offer some advantages, the one-staged exchange in periprosthetic joint infection (PJI) remains rare in the orthopedic world. Besides the reduced number of surgical interventions for the patients, it is usually associated with a decreased in-hospital stay and quicker mobilization. Furthermore, it might be the more cost-effective approach and allows for a reduced duration of postoperative systemic antibiotics, usually less than 14 days. Technically, the presence of a positive culture by preoperative aspiration or biopsy and respective antibiogram is mandatory. A cemented implant fixation using specified topic antibiotics, based on the antibiogram, is treatment of choice for one-staged procedures. The overall success is based on the well-defined and detailed intrahospital infrastructure, including a meticulous preoperative planning, joint aspiration regime, and aggressive intraoperative surgical approach. This article describes the one-staged exchange in infected PJI of the knee joint, which has been established 40 years ago in the HELIOS ENDO-Klinik Hamburg, Germany.

Keywords

periprosthetic joint infection - one-staged exchange - antibiotic - PJI
 

  • References

  • 1 Bozic KJ, Kurtz SM, Lau E , et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010; 468 (1) 45-51
    CrossrefPubMedGoogle 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 (8) 1746-1751
    CrossrefPubMedGoogle 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 Arthroplasty 2008; 23 (7) 984-991
    CrossrefPubMedGoogle Scholar
  • 4 Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 2010; 468 (1) 52-56
    CrossrefPubMedGoogle Scholar
  • 5 Fink B, Makowiak C, Fuerst M, Berger I, Schäfer 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 (7) 874-878
    PubMedGoogle Scholar
  • 6 Siegel A, Frommelt L, Runde W. Therapy of bacterial knee joint infection by radical synovectomy and implantation of a cemented stabilized knee joint endoprosthesis [in German]. Chirurg 2000; 71 (11) 1385-1391
    CrossrefPubMedGoogle Scholar
  • 7 Fehring TK, Odum S, Calton TF, Mason JB. Articulating versus static spacers in revision total knee arthroplasty for sepsis. The Ranawat Award. Clin Orthop Relat Res 2000; ;( (380) 9-16
    PubMedGoogle Scholar
  • 8 Haddad FS, Masri BA, Campbell D, McGraw RW, Beauchamp CP, Duncan CP. The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement. J Bone Joint Surg Br 2000; 82 (6) 807-812
    CrossrefPubMedGoogle Scholar
  • 9 Pietsch M, Wenisch C, Traussnig S, Trnoska R, Hofmann S. Temporary articulating spacer with antibiotic-impregnated cement for an infected knee endoprosthesis [in German]. Orthopade 2003; 32 (6) 490-497
    PubMedGoogle Scholar
  • 10 Wongworawat MD. Clinical faceoff: One- versus two-stage exchange arthroplasty for prosthetic joint infections. Clin Orthop Relat Res 2013; 471 (6) 1750-1753
    CrossrefPubMedGoogle Scholar
  • 11 Kurd MF, Ghanem E, Steinbrecher J, Parvizi J. Two-stage exchange knee arthroplasty: does resistance of the infecting organism influence the outcome?. Clin Orthop Relat Res 2010; 468 (8) 2060-2066
    CrossrefPubMedGoogle Scholar
  • 12 Mortazavi SM, Vegari D, Ho A, Zmistowski B, Parvizi J. Two-stage exchange arthroplasty for infected total knee arthroplasty: predictors of failure. Clin Orthop Relat Res 2011; 469 (11) 3049-3054
    CrossrefPubMedGoogle Scholar
  • 13 Parvizi J, Adeli B, Zmistowski B, Restrepo C, Greenwald AS. Management of periprosthetic joint infection: the current knowledge: AAOS exhibit selection. J Bone Joint Surg Am 2012; 94 (14) e104
    PubMedGoogle Scholar
  • 14 Osmon DR, Berbari EF, Berendt AR , et al; Infectious Diseases Society of America. Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013; 56 (1) 1-10
    PubMedGoogle Scholar
  • 15 Buechel FF. The infected total knee arthroplasty: just when you thought it was over. J Arthroplasty 2004; 19 (4) , Suppl (Suppl. 01) 51-55
    CrossrefPubMedGoogle Scholar
  • 16 Göksan SB, Freeman MA. One-stage reimplantation for infected total knee arthroplasty. J Bone Joint Surg Br 1992; 74 (1) 78-82
    PubMedGoogle Scholar
  • 17 Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004; 351 (16) 1645-1654
    CrossrefPubMedGoogle Scholar
  • 18 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
    PubMedGoogle Scholar
  • 19 Schäfer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis 2008; 47 (11) 1403-1409
    CrossrefPubMedGoogle Scholar
  • 20 von Foerster G, Klüber D, Käbler U. Mid- to long-term results after treatment of 118 cases of periprosthetic infections after knee joint replacement using one-stage exchange surgery [in German]. Orthopade 1991; 20 (3) 244-252
    PubMedGoogle Scholar
  • 21 Cats-Baril W, Gehrke T, Huff K, Kendoff D, Maltenfort M, Parvizi J. International consensus on periprosthetic joint infection: description of the consensus process. Clin Orthop Relat Res 2013; 471 (12) 4065-4075
    CrossrefPubMedGoogle Scholar
  • 22 Wahlig H, Dingeldein E, Buchholz HW, Buchholz M, Bachmann F. Pharmacokinetic study of gentamicin-loaded cement in total hip replacements. Comparative effects of varying dosage. J Bone Joint Surg Br 1984; 66 (2) 175-179
    PubMedGoogle Scholar
  • 23 Fink B, Vogt S, Reinsch M, Büchner H. 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 (11) 3141-3147
    CrossrefPubMedGoogle Scholar
  • 24 Winkler H, Kaudela K, Stoiber A, Menschik F. Bone grafts impregnated with antibiotics as a tool for treating infected implants in orthopedic surgery - one stage revision results. Cell Tissue Bank 2006; 7 (4) 319-323
    CrossrefPubMedGoogle Scholar
  • 25 Schildhauer TA, Robie B, Muhr G, Köller M. Bacterial adherence to tantalum versus commonly used orthopedic metallic implant materials. J Orthop Trauma 2006; 20 (7) 476-484
    CrossrefPubMedGoogle Scholar
  • 26 ICG; . ICG: International Consensus Group on Periprosthetic Infection. Consensus Statements. Philadelphia, PA: Thomas Jefferson University; August 1, 2013
  • 27 Hoad-Reddick DA, Evans CR, Norman P, Stockley I. Is there a role for extended antibiotic therapy in a two-stage revision of the infected knee arthroplasty?. J Bone Joint Surg Br 2005; 87 (2) 171-174
    PubMedGoogle Scholar
  • 28 Azzam K, McHale K, Austin M, Purtill JJ, Parvizi J. Outcome of a second two-stage reimplantation for periprosthetic knee infection. Clin Orthop Relat Res 2009; 467 (7) 1706-1714
    CrossrefPubMedGoogle Scholar
  • 29 Bauer T, Piriou P, Lhotellier L, Leclerc P, Mamoudy P, Lortat-Jacob A. Results of reimplantation for infected total knee arthroplasty: 107 cases [in French]. Rev Chir Orthop Reparatrice Appar Mot 2006; 92 (7) 692-700
    CrossrefPubMedGoogle Scholar
  • 30 Jenny JY, Barbe B, Gaudias J, Boeri C, Argenson JN. High infection control rate and function after routine one-stage exchange for chronically infected TKA. Clin Orthop Relat Res 2013; 471 (1) 238-243
    CrossrefPubMedGoogle Scholar
  • 31 Singer J, Merz A, Frommelt L, Fink B. High rate of infection control with one-stage revision of septic knee prostheses excluding MRSA and MRSE. Clin Orthop Relat Res 2012; 470 (5) 1461-1471
    CrossrefPubMedGoogle Scholar
  • 32 Goldman RT, Scuderi GR, Insall JN. 2-stage reimplantation for infected total knee replacement. Clin Orthop Relat Res 1996; (331) 118-124
    PubMedGoogle Scholar
  • 33 Buechel FF, Femino FP, D'Alessio J. Primary exchange revision arthroplasty for infected total knee replacement: a long-term study. Am J Orthop 2004; 33 (4) 190-198 , discussion 198
    PubMedGoogle Scholar
  • 34 Schmitz HC, Schwantes B, Kendoff D. One-stage revision of knee endoprosthesis due to periprosthetic infection and Klippel-Trenaunay syndrome [in German]. Orthopade 2011; 40 (7) 624-626 , 628–629
    CrossrefPubMedGoogle Scholar