The two-stage standard in revision total hip replacement

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Biomaterials Science

Background:

• Periprosthetic joint infection (PJI) is a serious complication following total hip replacement (THR).
• Two-stage exchange surgery is the established gold standard for managing THR PJI.
• Effective management requires thorough infection eradication before reimplantation.

Purpose of the Study:

• To describe the established two-stage exchange protocol for treating peri-prosthetic joint infection after total hip replacement.
• To outline the critical steps and considerations for each stage of the surgical treatment.

Main Methods:

• Surgical removal of all prosthetic components and cement.
• Thorough debridement and synovectomy.
• Implantation of an antibiotic-loaded cement spacer.
• Intravenous antibiotic therapy for six weeks.
• Post-treatment antibiotic-free period with clinical and serological monitoring.
• Second-stage revision surgery including spacer removal, repeat debridement, and new THR implantation.

Main Results:

• The two-stage exchange protocol involves distinct surgical and antibiotic phases.
• Successful infection eradication is assessed through clinical evaluation and serum inflammatory markers.
• The protocol aims to restore joint function while eradicating infection.

Conclusions:

• The two-stage exchange procedure is a comprehensive approach for treating THR periprosthetic joint infection.
• Careful execution of both surgical stages and the antibiotic regimen is crucial for successful outcomes.
• This protocol provides a framework for managing complex hip replacement infections.