The Role of One-Stage Exchange for Prosthetic Joint Infection.

September 2, 2018 at 7:02 pm

Curr Rev Musculoskelet Med. July 9, 2018

Rowan FE1,2, Donaldson MJ3,4, Pietrzak JR3,4, Haddad FS3,4.

Author information

1 Department of Orthopaedic Surgery, University College London Hospital, 250 Euston Road, London, NW1 2PG, UK. fiachrarowan@rcsi.ie.

2 The Princess Grace Hospital, 42-52 Nottingham Place, Marylebone, London, W1U 5NY, UK. fiachrarowan@rcsi.ie.

3 Department of Orthopaedic Surgery, University College London Hospital, 250 Euston Road, London, NW1 2PG, UK.

4 The Princess Grace Hospital, 42-52 Nottingham Place, Marylebone, London, W1U 5NY, UK.

Abstract

PURPOSE OF REVIEW:

In an era of increasing numbers of hip and knee replacements, strategies to manage prosthetic joint infection (PJI) that are effective at infection control with good patient-reported outcomes and cost containment for health systems are needed. Interest in single-stage exchange for PJI is rising and we assess evidence from the last 5 years related to this treatment strategy.

RECENT FINDINGS:

Only five series for total knee replacement and ten series for total hip replacement have been reported in the last five years. More review articles and opinion pieces have been written. Reinfection rates in these recent studies range from 0 to 65%, but a meta-analysis and systematic review of all studies showed a reinfection rate of 7.6% (95% CI 3.4-13.1) and 8.8% (95% CI 7.2-10.6) for single-stage and two-stage revisions respectively. There is emerging evidence to support single-stage revision in the setting of significant bony deficiency and atypical PJIs such as fungal infections. Prospective randomised studies are recruiting and are necessary to guide the direction of single-stage revision selection criteria. The onus of surgical excellence in mechanical removal of implants, necrotic tissue, and biofilms lies with the arthroplasty surgeon and must remain the cornerstone of treatment. Single-stage revision may be considered the first-line treatment for all PJIs unless the organism is unknown, the patient is systemically septic, or there is a poor tissue envelope.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6105475/pdf/12178_2018_Article_9499.pdf

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Entry filed under: Antimicrobianos, Bacterias, Epidemiología, FIEBRE en el POSTOPERATORIO, Health Care-Associated Infections, Infecciones en piel y tej blandos, Infecciones nosocomiales, Infecciones osteo-articulares-musculares, Infecciones relacionadas a prótesis, Metodos diagnosticos, Profilaxis Antibiótica en Cirugía - PAC, REPORTS, Resistencia bacteriana, Sepsis, Update.

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