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Surgical management of periprosthetic joint infection: one-stage exchange
Daniel Kendoff1, Thorsten Gehrke1
1Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Germany.
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.
Insights
One-stage exchange for periprosthetic joint infection (PJI) offers benefits like fewer surgeries and shorter hospital stays. This approach requires precise planning and antibiotic-guided cemented fixation for successful outcomes in knee PJI.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
Background:
- Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery.
- One-stage exchange for PJI is infrequently performed despite potential patient benefits.
Purpose of the Study:
- To describe the established one-stage exchange procedure for infected knee PJI.
- To highlight the advantages and technical requirements of this surgical approach.
Main Methods:
- Mandatory preoperative positive cultures and antibiogram.
- Cemented implant fixation with antibiotics guided by antibiogram.
- Meticulous preoperative planning and aggressive surgical approach.
Main Results:
- Reduced number of surgical interventions.
- Decreased in-hospital stay and quicker patient mobilization.
- Shorter duration of postoperative antibiotics (typically <14 days).
Conclusions:
- One-stage exchange for knee PJI, when meticulously planned and executed, can be a successful and cost-effective treatment.
- Requires a robust intrahospital infrastructure and adherence to specific technical protocols.
