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One-stage revision yields higher survival rate for infected total joint procedures
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SAN FRANCISCO — Although two-stage revisions are more popular, one-stage revisions are more successful, cost effective and less debilitating for patients undergoing revision total hip arthroplasty and total knee arthroplasty as a result of infection, according to a recent presentation.
Gerhard E. Maale, MD, and colleagues analyzed the first 200 cases of one-stage revision arthroplasty with minimum 2-year follow-up. In addition, they retrospectively examined prior surgical numbers from prior studies, including complications and relapse, stage, pathology, and intramural and extramural reports, according to the abstract.
Ninety percent of one-stage revisions and 85% of two-stage revisions were successful, Maale stated in his presentation at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting, here. Even after draining sinuses with visualized prosthesis, the retrieval rate was less than 25% and 40% of patients were culture positive at referring institutions, according to the abstract.
“The key to success is what we call gradual debridement,” Maale said. “It is the removal of all infected tissue, both hard and soft, removal of prosthetic devices – anything that can get or form biofilm. The key is to get rid of the biofilm-immediated infection.”
Reference:
Maale GE, Eager J. Evolution of the two-stage revision to the one-stage revision with immediate exchange for infected total joints. Paper #121. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
Disclosure: Maale receives royalties from Biocomposites, is on the speaker’s bureau for A Cell, is a paid consultant for Stryker and Smith & Nephew and receives stock options from NRG.
