title: One-stage revision of infected hip arthroplasty: outcome of 39 consecutive hips.
abstract: There are various options for treating periprosthetic joint infection (PJI). Two-stage exchange has traditionally been the gold standard. However, if the appropriate surgical intervention is chosen according to a rational algorithm, the outcome is similar when using all types of interventions. In an observational cohort study, the outcome of patients with PJI after hip replacement treated with one-stage revision was analysed.
  
  
  
  All patients fulfilling all criteria for one-stage exchange according to the Infectious Diseases Society of America (IDSA) guidelines and six without preoperative identification of a microorganism were included. Implant removal, debridement and cemented or uncemented reimplantations were performed in a single intervention. If a cemented device was implanted, commercially available gentamicin cement was used in all cases. Antibiotic treatment was administered intravenously for at least 2 weeks, followed by oral therapy for a total duration of 3 months. Patients had standardised clinical and radiological follow-up visits.
  
  
  
  Between 1996 and 2011, 38 patients (39 hips) were treated with a one-stage procedure and followed for at least 2 years. Coagulase-negative staphylococci were the most frequent pathogens, and polymicrobial infection was observed in five cases. In 25 hips, an uncemented revision stem was implanted, and 37 hips received an acetabular reinforcement ring. The mean follow-up was 6.6 (2.0-15.1) years. No patient had persistent, recurrent or new infection. There were four stem revisions for aseptic loosening. The mean Harris Hip Score was 81 points (26-99) at the final follow-up.
  
  
  
  Excellent cure rate and function seen in our study suggest that one-stage exchange is a safe procedure, even without local antibiotic treatment, provided that the patient has no sinus tract or severe soft tissue damage, no major bone grafting is required and the microorganism is susceptible to orally administered agents with high bioavailability.
authors.affiliation: Hirslanden Klink Birshof, Münchenstein, Switzerland. thomas.ilchmann@hirslanden.ch.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ilchmann
authors.affiliation: Interdisciplinary Unit for Orthopaedic Infections and Basel University Medical Clinic, Kantonsspital Baselland Liestal, Liestal, Switzerland.
authors.forename: Werner
authors.initials: W
authors.lastname: Zimmerli
authors.affiliation: Interdisciplinary Unit for Orthopaedic Infections and Clinic for Orthopaedics and Trauma Surgery, Kantonsspital Baselland Liestal, Liestal, Switzerland.
authors.forename: Peter Emil
authors.initials: PE
authors.lastname: Ochsner
authors.affiliation: Interdisciplinary Unit for Orthopaedic Infections and Basel University Medical Clinic, Kantonsspital Baselland Liestal, Liestal, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kessler
authors.affiliation: Clinic for Orthopaedics and Trauma Surgery, Kantonsspital Baselland Liestal, Liestal, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Zwicky
authors.affiliation: Interdisciplinary Unit for Orthopaedic Infections and Basel University Medical Clinic, Kantonsspital Baselland Liestal, Liestal, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Graber
authors.affiliation: Interdisciplinary Unit for Orthopaedic Infections and Clinic for Orthopaedics and Trauma Surgery, Kantonsspital Baselland Liestal, Liestal, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Clauss
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006615:Hip; D006621:Hip Joint / Q000382:microbiology / Q000601:surgery; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000628:therapy*; D012086:Reoperation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Hip arthroplasty; Hip replacement; Infection; One-stage; Treatment; Uncemented