title: Two stage hip revision in periprosthetic infection: results of 41 cases.
abstract: BACKGROUND
  two-stage revision is considered the best treatment approach for the eradication of chronic joint infection. We report the outcome of 41 consecutive patients with infected hip prostheses, treated between 2000 and 2005, with two-stage revision using an antibiotic-loaded cement spacer.
  
  
  METHODS
  Patients underwent a treatment protocol which included clinical and radiographic evaluation, laboratory investigations, hip aspiration, 99mTc-MDP and 99mTc-leukocyte-labeled scintigraphy and intraoperative assessment. All patients were diagnosed with a late chronic infection and classified as B-host according to the Cierny-Mader classification system. 9 patients out of 41 (22%) required a second interim treatment period, with exchange of the spacer. The proportion of methicillin-resistant Staphylococcus was similar between the one-spacer group and two-spacer group (28% vs 33%), whereas the proportion of patients with three or more risk factors was significantly higher in the two-spacer group than in the one-spacer group (28% vs 55%, respectively).
  
  
  RESULTS
  Forty patients had final reimplantation, one patient had a resection arthroplasty. At an average follow-up of 5.3 years no recurrence of infection occurred. The average post-operative Harris hip score improved from 41 to 80.
  
  
  CONCLUSIONS
  In the treatment of two-stage revision arthroplasty the adherence to the protocol proved to be effective for infection eradication and final reimplantation.
authors: 7 Ward of Orthopedic-Trauma Surgery, Rizzoli Orthopedic Institute, Bologna, Italy.
authors: Giovanni
authors: G
authors: Pignatti
authors: Shingo
authors: S
authors: Nitta
authors: Nicola
authors: N
authors: Rani
authors: Dante
authors: D
authors: Dallari
authors: Giacomo
authors: G
authors: Sabbioni
authors: Cesare
authors: C
authors: Stagni
authors: Armando
authors: A
authors: Giunti