title: Prosthetic joint infection following total hip replacement: results of one-stage versus two-stage exchange.
abstract: OBJECTIVE
  Prosthetic hip joint infection remains a challenging socio-economic problem. Curative treatment is usually a one- or two-stage revision surgery, but neither of these options has yet emerged as the treatment of choice. The aim of this study was to evaluate which of these methods produced superior outcomes.
  
  
  METHODS
  A retrospective study was performed including 92 patients with deep infections after implantation of primary total hip arthroplasty (THA) who had undergone either one-stage or two-stage revision surgery at a single centre. Infections were classified according to McPherson and we evaluated the rate of persisting infection or reinfection after surgical intervention.
  
  
  RESULTS
  The two-stage revision surgery revealed superior outcomes for the analysed infection categories compared to the one-stage procedure except for the least serious category of infections (i.e. McPherson Stage I/A/1, early postoperative infection, no systemic comorbidities, local status uncompromised). Eradication of prosthetic infection was achieved in 94.5 % (n = 52) within the group of two-stage exchange, and 56.8 % (n = 21) of patients treated with a one-stage procedure. Outcome of patients following a one-stage or a two-stage exchange was overall significantly different with p < 0.001. Further deviations between the described two procedures were noted in the subgroups following the classification described by McPherson.
  
  
  CONCLUSIONS
  Our results indicate superiority of two-stage revision surgery in case of serious infections. The authors believe that decisions on the surgical approach for the treatment of deep prosthesis infections should be made on the basis of standardized staging systems.
authors.affiliation: Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Wolf
authors.forename: Heimo
authors.initials: H
authors.lastname: Clar
authors.forename: Jörg
authors.initials: J
authors.lastname: Friesenbichler
authors.forename: Gerold
authors.initials: G
authors.lastname: Schwantzer
authors.forename: Gerwin
authors.initials: G
authors.lastname: Bernhardt
authors.forename: Gerald
authors.initials: G
authors.lastname: Gruber
authors.forename: Mathias
authors.initials: M
authors.lastname: Glehr
authors.forename: Andreas
authors.initials: A
authors.lastname: Leithner
authors.forename: Patrick
authors.initials: P
authors.lastname: Sadoghi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D055815:Young Adult