Letter to the Editor: Treatment of Early Postoperative Infections After THA: A Decision Analysis

Wolf, Matthias; Leithner, Andreas; Clar, H. E.

doi:10.1007/s11999-012-2359-7

Cited by 2 publications

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References 3 publications

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“…On the other hand, eradication with the two-step procedure is given as 75-100 % [8,9,11,12]. Large numbers of cases have been obtained by collecting data in meta-analyses and systematic reviews [20,21]. Although great efforts were made in the comparison of large numbers of very different patients in the various studies it is questionable whether the published data, in spite of the best statistical concepts, can be collected this way and then be comparable [20,21].…”

Section: Discussionmentioning

confidence: 99%

Prosthetic joint infection following total hip replacement: results of one-stage versus two-stage exchange

Wolf

Clar

Friesenbichler

et al. 2014

International Orthopaedics (SICOT)

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Purpose Prosthetic hip joint infection remains a challenging socio-economic problem. Curative treatment is usually a oneor two-stage revision surgery, but neither of these options has yet emerged as the treatment of choice. The aim of this study was to evaluate which of these methods produced superior outcomes. Methods A retrospective study was performed including 92 patients with deep infections after implantation of primary total hip arthroplasty (THA) who had undergone either onestage or two-stage revision surgery at a single centre. Infections were classified according to McPherson and we evaluated the rate of persisting infection or reinfection after surgical intervention. Results The two-stage revision surgery revealed superior outcomes for the analysed infection categories compared to the onestage procedure except for the least serious category of infections (i.e. McPherson Stage I/A/1, early postoperative infection, no systemic comorbidities, local status uncompromised).Eradication of prosthetic infection was achieved in 94.5 % (n=52) within the group of two-stage exchange, and 56.8 % (n = 21) of patients treated with a one-stage procedure. Outcome of patients following a one-stage or a two-stage exchange was overall significantly different with p<0.001. Further deviations between the described two procedures were noted in the subgroups following the classification described by McPherson. ConclusionsOur results indicate superiority of two-stage revision surgery in case of serious infections. The authors believe that decisions on the surgical approach for the treatment of deep prosthesis infections should be made on the basis of standardized staging systems.

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