Systematic review of single stage revision for prosthetic joint infection

Abstract

While advanced technology, increased medical knowledge and improved surgical technique has improved patient outcomes in total joint arthroplasty, prosthetic joint infection still remains one of the leading causes of increased healthcare costs, medical resources and societal burdens in orthopaedic care. Two stage arthroplasty revision remains the gold standard for treatment of prosthetic joint infection. Proponents of single stage revision arthroplasty for infection argue that it results in lower healthcare costs while improving patient reported functional outcomes and with equivalent success rates. Here we review the history of single stage revision arthroplasty, discuss the key principles, highlight the indications and contraindications, and review the reported outcomes with a focus on future developments of single stage revision arthroplasty for hip and knee periprosthetic joint infections.

Efficiency of the One-Stage Revision Hip Arthroplasty in Chronic Periprosthetic Joint Infection with Sinus Tract

“…Buchholz с соавторами [16], посвященной десятилетнему опыту одноэтапного реЭП, операция приобрела множество убежденных сторонников и противников. С тех пор опубликованы тематические метаанализы, отчеты о работе международных согласительных конференций, и острота дискуссии существенно уменьшилась, а в сообществе ортопедов формируется единый подход к выбору хирургической тактики [7,20,21]. Тем не менее не для всех проблем найдено очевидное решение.…”

Management strategies for prosthetic joint infection: long-term infection control rates, overall survival rates, functional and quality of life outcomes

“…It is indicated in acute (less than four weeks from index operation), rather in chronic post-operative infections, good soft tissue envelope, known gram-positive pathogen with good antibiotic sensitivity and minimally inhibitory bacterial concentrations, and when host grade is not compromised. 29 , 30 Extensive debridement with removal of all devitalized tissue material during the operation is one of the most important factors affecting the final outcome. Local and systemic antibiotic delivery tailored to the known pathologic organism is an integral part of the technique, but the duration of systematic antibiotic administration is still being discussed.…”

“…Local and systemic antibiotic delivery tailored to the known pathologic organism is an integral part of the technique, but the duration of systematic antibiotic administration is still being discussed. 29 – 31 Early to medium-term infection control, for properly indicated single-stage revision, varies from 77–100% across a variety of studies. 29 – 31 The Hamburg Group reported a minimum 10-year infection-free survival of 94% and surgery-free survival of 75.9% in 85 hips undergoing one-stage revision with cemented implants.…”

“… 29 – 31 Early to medium-term infection control, for properly indicated single-stage revision, varies from 77–100% across a variety of studies. 29 – 31 The Hamburg Group reported a minimum 10-year infection-free survival of 94% and surgery-free survival of 75.9% in 85 hips undergoing one-stage revision with cemented implants. 32 The same group reported 10–24 year infection-free survival of 96.2% and surgery-free survival of 76.9% in 26 hips in patients younger than 45 years.…”

To DAIR or not to DAIR: Decision-making in the management of acute prosthetic joint infection � A narrative review

“…Whether prosthesis extraction is followed by definite arthrodesis, one-step revision, or two-step exchange procedure, the common denominator of this strategy is to remove the foreign body and the bacterial biofilm, which significantly facilitates the healing of the infection [12][13][14] . The two-stage revision is considered to be the gold standard procedure, with high rates of success (11%, range 0-25%) 15 , although comparable results have been reported in single-stage revisions in well-selected patients 16 .…”