title: One-stage exchange arthroplasty for chronic periprosthetic hip infection: results of a large prospective cohort study.
abstract: BACKGROUND
  Exchange arthroplasty of one or two stages is required for the treatment of chronic periprosthetic joint infections. Two-stage exchange is costly and has high morbidity with limited patient mobility between procedures. One-stage exchange has been promoted by several European teams as the preferred alternative. The aim of this study was to prospectively analyze the outcome of patients with a periprosthetic hip infection treated with one-stage exchange arthroplasty.
  
  
  METHODS
  We performed a prospective cohort study in a French referral center for osteoarticular infections including all periprosthetic hip infections treated with one-stage exchange arthroplasty from November 2002 to March 2010. Direct exchange was performed in chronic periprosthetic hip infection with no or minor bone loss and preoperative identification of a microorganism from joint fluid aspirate. No antibiotic-loaded bone cement was used. Antibiotic therapy was administered for twelve weeks: intravenously for four to six weeks, followed by an oral regimen for six to eight weeks. Follow-up was a minimum of two years. The following events were noted: relapse, new infection, joint revision for mechanical reasons, and periprosthetic hip infection-related and unrelated deaths.
  
  
  RESULTS
  One hundred and fifty-seven patients with periprosthetic hip infections with a median infection duration of 258 days (interquartile range, 120 to 551 days) prior to our index surgical procedure for infection were included. Periprosthetic hip infection occurred in ninety-nine cases of primary hip arthroplasty, twenty-seven cases of revision arthroplasty, and thirty-one cases in which the periprosthetic hip infection had been treated previously. A difficult-to-treat organism was isolated in fifty-nine cases (38%). After a median follow-up of 41.6 months (interquartile range, 28.1 to 66.9 months), two relapses, six new infections, nine revisions for mechanical reasons, two related deaths, and nineteen unrelated deaths occurred.
  
  
  CONCLUSIONS
  One-stage exchange arthroplasty is an effective surgical procedure in patients with periprosthetic hip infection who have good bone quality. Precise identification of the microorganism(s) and prolonged administration of appropriate intravenous antibiotic therapy are key factors for successful treatment.
authors.affiliation: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France. E-mail address for V. Zeller: vzeller@hopital-dcss.org.
authors.forename: Valérie
authors.initials: V
authors.lastname: Zeller
authors.affiliation: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France. E-mail address for V. Zeller: vzeller@hopital-dcss.org.
authors.forename: Luc
authors.initials: L
authors.lastname: Lhotellier
authors.affiliation: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France. E-mail address for V. Zeller: vzeller@hopital-dcss.org.
authors.forename: Simon
authors.initials: S
authors.lastname: Marmor
authors.affiliation: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France. E-mail address for V. Zeller: vzeller@hopital-dcss.org.
authors.forename: Philippe
authors.initials: P
authors.lastname: Leclerc
authors.affiliation: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France. E-mail address for V. Zeller: vzeller@hopital-dcss.org.
authors.forename: Alysa
authors.initials: A
authors.lastname: Krain
authors.affiliation: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France. E-mail address for V. Zeller: vzeller@hopital-dcss.org.
authors.forename: Wilfrid
authors.initials: W
authors.lastname: Graff
authors.affiliation: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France. E-mail address for V. Zeller: vzeller@hopital-dcss.org.
authors.forename: Françoise
authors.initials: F
authors.lastname: Ducroquet
authors.affiliation: Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, 1, avenue Claude Vellefaux, AP-HP, Paris Université 7, 75475 Paris Cedex 10, France.
authors.forename: David
authors.initials: D
authors.lastname: Biau
authors.affiliation: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France. E-mail address for V. Zeller: vzeller@hopital-dcss.org.
authors.forename: Philippe
authors.initials: P
authors.lastname: Leonard
authors.affiliation: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France. E-mail address for V. Zeller: vzeller@hopital-dcss.org.
authors.forename: Nicole
authors.initials: N
authors.lastname: Desplaces
authors.affiliation: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France. E-mail address for V. Zeller: vzeller@hopital-dcss.org.
authors.forename: Patrick
authors.initials: P
authors.lastname: Mamoudy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002908:Chronic Disease; D003663:Decision Trees; D005260:Female; D005602:France / Q000453:epidemiology; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents