Efficiency of two-stage revision arthroplasty in management of periprosthetic knee and hip joint infection

Balaev A.M., Borzunov N.M., Ababkov I.V., Triapichnikov A.S., Koiushkov A.N.

Abstract


Introduction
Two-stage revision arthroplasty is the "gold standard" of surgical treatment of periprosthetic infection in most domestic and foreign hospitals. This technique involves removal of implant components, debridement of the purulent focus and installation of a cement spacer which is subsequently replaced with a permanent implant after 3–9 months.
Purpose
To evaluate mid-term results of two-stage surgical treatment of patients with chronic periprosthetic infection of the knee and hip joints.
Materials and methods
Treatment outcomes of 172 patients with periprosthetic infection who underwent two-stage revision arthroplasty in the period from 2011 to 2015 were assessed. Among them, 113 patients developed infection after hip replacement and 59 patients had infected knee joint. The average follow-up period was 4 ± 1.58 years (range: 2 to 6 years).
Results
Out of 113 two-stage procedures of hip joint revision, 102 (90.2%) cases showed an arrest of infection. Four (3.6%) patients with recurrence of the purulent process underwent resection arthroplasty, another four (3.6%) rejected to replace the spacer with an implant, and three (2.6%) had a two-stage re-revision. Out of 60 (59 patients) procedures of a two-stage knee joint revision, infection was arrested in 50 (83.3%) cases; eight (13.4%) had recurrence and underwent knee arthrodesis. One (1.6 %) refused to replace a spacer for an implant, and one more (1.6%) had a two-stage repeated revision.
Conclusions
Two-stage knee and hip revision arthroplasty using a cement spacer is an effective option for treatment of chronic periprosthetic infection. It provides infection control in 86.7% (83.3% for knee and 90.2 % for hip joints) of cases in the mid-term follow-up period up to 5 years. However, the rate of re-infection remains significant and reaches 13.3 % (9.8% for hip and 16.7 % for knee joints).

Keywords


arthroplasty, hip, knee, periprosthetic infection, treatment, two stage revision.

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