Two-stage exchange hip arthroplasty for deep infection

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Biomedical Engineering

Background:

• Deep infection following total hip arthroplasty (THA) remains a significant complication despite advancements in prophylaxis and surgical environments.
• Improved diagnostic tools, such as polymerase chain reaction (PCR) amplification, aid in identifying infections.
• Despite decreased infection rates, substantial patient morbidity and healthcare costs persist.

Purpose of the Study:

• To review current treatment strategies for deep periprosthetic joint infections (PJIs) after THA.
• To compare the efficacy of different surgical protocols, including one-stage and two-stage reimplantation.
• To identify ongoing controversies and areas for future research in managing THA infections.

Main Methods:

• Systematic review of medical literature on total hip arthroplasty infections.
• Analysis of diagnostic techniques, including polymerase chain reaction amplification.
• Evaluation of various treatment modalities: suppressive antibiotics, irrigation and debridement, one-stage reimplantation, two-stage reimplantation, and salvage procedures.

Main Results:

• Two-stage reimplantation protocols demonstrate a >90% success rate for eradicating deep joint infections.
• One-stage reimplantation protocols achieve an approximate 80% success rate.
• Success rates may be compromised by the increasing prevalence of antibiotic-resistant organisms.

Conclusions:

• Two-stage reimplantation is a highly effective treatment for deep periprosthetic joint infections after total hip arthroplasty.
• Ongoing debates surround optimal antibiotic duration, surgical timing, allograft use, fixation methods, and antibiotic-loaded cement spacers in two-stage protocols.
• The rise of antibiotic resistance poses a future challenge to the successful management of these infections.