Abstract
A definitive consensus on the optimal limb salvage protocol for infected total joints does not currently exist. Popular, is the two-stage revision which calls for the use of an antibiotic loaded spacer followed by a delayed exchange. Our question is whether single-stage revisions for biofilm based infected arthroplasties results in comparable or possibly better patient outcomes as compared to those reported for two-stage revisions. We retrospectively reviewed 500 cases of one-stage revisions for periprosthetic joint infections (PJI) using dual setup with radical debridement, definitive reconstruction with antibiotic loaded cement and implantation of antibiotic calcium sulfate pellets between the years 2005–2017. The revisions included 351 total knees, 122 hips, 2 hip-femur-knees, 13 shoulders, 10 elbows, and 2 shoulder-humerus-elbows. The patient population had a mean follow-up of 60 months (range: 24 months–14 years) and mean patient age of 61 years old, consisting of 250 males and 250 females. Patient comorbidities were reviewed, classified using McPherson’s staging for PJIs, and compared to the Cierny & Mader classification system. Successful treatment was defined as a joint without recurrence of infection, for a minimum of 2 years, and limb preservation. Based on our findings, one-stage revision of PJIs demonstrates at least as good an infection eradication rate as two-stage revision: 88% vs 85% respectively.
Highlights
The occurrence of deep infection of total joints is a serious complication requiring aggressive management to eradicate infection and salvage the joint
These collections of microorganisms, through a process identified as quorum sensing, have the ability to interact via secretion and detection of diffusible signals
65.6 a Incidence of more than one infecting organism was classified as polyclonal. These principles involve removal of all hardware, radical debridement which we define as removal of all biofilm infected tissues, either placement of a stabilized spacer for the joint or a definitive reconstruction with antibiotic loaded cement and antibiotic loaded calcium sulfate hemihydrate pellets
Summary
The occurrence of deep infection of total joints is a serious complication requiring aggressive management to eradicate infection and salvage the joint. The fundamental concepts for treatment of PJI described the necessity for implants, foreign bodies, and cement removal in combination with radical debridement, the process of removing dead soft tissue and bone This is coupled with the use of antibiotic loaded cement and other. Extensive radical debridement is essential for removal of the biofilm-based infection This requires an “oncologictype” of surgical debridement which includes removal of all prosthetic components, dead and reactive tissues, and foreign material such as braided sutures and prosthetic debris [13]. In scenarios where there is inadequate soft tissue, provisions must be made for local and free muscle flaps It requires mobilization of adjacent vessels and nerves in and around the joint as well as resection of involved dead ligaments and tendons that are infected with biofilm. Our purpose was to question the effectiveness of a one-stage procedure in controlling total joint infection as compared to the more commonly accepted two-stage approach
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