title: One-stage exchange: it all began here.
abstract: Based on the first implementation of mixing antibiotics into bone cement in the 1970s, the Endo-Klinik has used one stage exchange for prosthetic joint infection (PJI) in over 85% of cases. Looking carefully at current literature and guidelines for PJI treatment, there is no clear evidence that a two stage procedure has a higher success rate than a one-stage approach. A cemented one-stage exchange potentially offers certain advantages, mainly based on the need for only one operative procedure, reduced antibiotics and hospitalisation time. In order to fulfill a one-stage approach, there are obligatory pre-, peri- and post-operative details that need to be meticulously respected, and are described in detail. Essential pre-operative diagnostic testing is based on the joint aspiration with an exact identification of any bacteria. The presence of a positive bacterial culture and respective antibiogram are essential, to specify the antibiotics to be loaded to the bone cement, which allows a high local antibiotic elution directly at the surgical side. A specific antibiotic treatment plan is generated by a microbiologist. The surgical success relies on the complete removal of all pre-existing hardware, including cement and restrictors and an aggressive and complete debridement of any infected soft tissues and bone material. Post-operative systemic antibiotic administration is usually completed after only ten to 14 days.
authors.affiliation: Helios Endo Klinik Hamburg, Holstenstr.2, 22767 Hamburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Gehrke
authors.forename: A
authors.initials: A
authors.lastname: Zahar
authors.forename: D
authors.initials: D
authors.lastname: Kendoff
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D019643:Arthroplasty, Replacement; D001182:Arthroscopy; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D001843:Bone Cements / Q000494:pharmacology*; D003131:Combined Modality Therapy; D003646:Debridement; D020878:Device Removal; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D013396:Suction; D013525:Surgical Instruments; D013582:Synovial Fluid / Q000382:microbiology; D007507:Therapeutic Irrigation
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D001843:Bone Cements
keywords: antibiotic cement; endo clinic; joint aspiration; one staged exchange; periprosthetic infection