Two-stage revision arthroplasty for management of chronic periprosthetic hip and knee infection: techniques, controversies, and outcomes.

In North America, two-stage revision arthroplasty is the treatment of choice for chronic periprosthetic infection of the hip and knee. Controversy exists regarding the diagnosis of persistent infection, cement spacer design, and duration of antibiotic therapy. Erythrocyte sedimentation rate and C-reactive protein tests have no clear cutoff values for detecting infection before reimplantation of hardware, and aspiration for microbial culture can yield false-negative results. Mobile spacers are as effective as static spacers for eradicating infection, but mobile spacers provide better interim function and may help to make the second stage of surgery technically easier. Some articulating spacer designs have fewer reports of spacer dislocation and fracture than do others. Although prolonged antibiotic therapy has been the standard of care for two-stage procedures, some have suggested that a short course of antibiotics is just as effective. When infection persists despite antibiotic therapy, the second stage of revision arthroplasty should be delayed until the first stage of the procedure is repeated.