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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Two stage revision: indications, techniques and results.

Massimo Franceschini1, Leopoldo Pedretti1, Vincenzo Cerbone1

  • 1Istituto Ortopedico "G. Pini", II Orthopaedic Clinic, University of Milan, Milan, Italy.

Annals of Joint
|March 26, 2024
PubMed
Summary

Periprosthetic joint infection (PJI) management requires precise diagnosis and surgical technique. Two-stage revision surgery is a key approach for complex PJI cases, especially when single-stage revision is contraindicated.

Keywords:
Periprostheticinfectionjointrevisiontwo stage

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Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Biomedical Engineering

Background:

  • Periprosthetic joint infection (PJI) presents significant challenges in joint replacement surgery.
  • A numerical diagnostic tool was proposed at the 2018 International Consensus Meeting (ICM).
  • PJI can be devastating for patients and complex for surgeons.

Purpose of the Study:

  • To outline the indications and methodology for two-stage revision surgery in PJI.
  • To highlight contraindications for single-stage revision.
  • To emphasize the need for standardized diagnostic and treatment protocols for PJI.

Main Methods:

  • Review of the two-stage prosthetic revision technique described by Insall et al.
  • Identification of contraindications for single-stage revision (e.g., soft tissue compromise, resistant organisms).
  • Description of the two-stage process: prosthesis removal, debridement, interval spacer, antibiotics, and delayed reconstruction.

Main Results:

  • Two-stage revision is indicated when single-stage revision is not feasible due to specific patient or pathogen factors.
  • The interval between stages can vary from 6 weeks to several months.
  • Exact preoperative diagnosis and appropriate technique are crucial for successful PJI treatment.

Conclusions:

  • Two-stage revision surgery is a critical strategy for managing complex periprosthetic joint infections.
  • Further research is needed to optimize timing, antibiotic duration, and diagnostic standardization for PJI.
  • Effective management of PJI demands expertise in diagnosis and surgical intervention.