Treatment for periprosthetic infection with two-stage revision arthroplasty with a gentamicin loaded spacer. The clinical outcomes.

BACKGROUND

With the increasing number of total joint replacement procedures, the number of complications from that surgery has also been on the rise. Although quite rare (<1%), a PPI may ruin even the best and technically excellent joint replacement procedure, causing extensive damage and loss of bone and periprosthetic tissues, which makes subsequent restoration surgery extremely difficult. At present, a two-stage revision arthroplasty seems to be the best solution for PPI patients [4,9,15]. In the first stage, implant removal and radical débridement of infected tissues is performed and an antibiotic-loaded spacer is inserted. After a few months, the second stage is performed where the spacer is removed and a revision endoprosthesis is implanted. The aim of the study was to evaluate the effectiveness of treatment for periprosthetic infections with a two-stage revision arthroplasty.

MATERIAL AND METHODS

Forty-one patients diagnosed with PPI were treated at the Department of Orthopedic and Trauma Surgery, Silesian Medical University in Katowice, between January 2007 and March 2010. PPI was a complication of knee arthroplasty (12 patients, 29%) and hip replacement (29 patients, 71%). During the first stage of the treatment, intraoperative cultures were negative in 17 patients (41%) and positive in 24 (59%).

RESULTS

Cultures obtained in patients with reinfection after revision endoprosthesoplasty (second stage of the treatment) grew no pathogen in 1 patient, MSSA (1), E. faecalis (1), and A. baumanii with MSSA and MRSE (1). After the first stage of the treatment (spacer implantation), infection was not cured in one patient (2.5%). In 4 patients (10%), there was reinfection after the implantation of a revision endoprosthesis.

CONCLUSIONS

Our analysis provides evidence to suggest that two-stage revision endoprosthesoplasty is an effective method of treatment of periprosthetic infections.