title: The two-stage standard in revision total hip replacement.
abstract: Two-stage exchange remains the gold standard for treatment of peri-prosthetic joint infection after total hip replacement (THR). In the first stage, all components and associated cement if present are removed, an aggressive debridement is undertaken including a complete synovectomy, and an antibiotic-loaded cement spacer is put in place. Patients are then treated with six weeks of parenteral antibiotics, followed by an 'antibiotic free period' to help ensure the infection has been eradicated. If the clinical evaluation and serum inflammatory markers suggest the infection has resolved, then the second stage can be completed, which involves removal of the cement spacer, repeat debridement, and placement of a new THR.
authors.affiliation: Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, New York 10075, USA .
authors.forename: H J
authors.initials: HJ
authors.lastname: Cooper
authors.forename: C J
authors.initials: CJ
authors.lastname: Della Valle
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D019644:Arthroplasty, Replacement, Hip / Q000592:standards*; D015415:Biomarkers / Q000097:blood; D001843:Bone Cements / Q000494:pharmacology*; D003646:Debridement; D020878:Device Removal; D006801:Humans; D016459:Prosthesis-Related Infections / Q000628:therapy*; D012086:Reoperation / Q000592:standards*
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D001843:Bone Cements
keywords: antibiotic spacer; periprosthetic joint infection; total hip replacement; two-stage exchange