title: 2-stage revision of 120 deep infected hip and knee prostheses using gentamicin-PMMA beads.
abstract: Background and purpose - A 2-stage revision is the most common treatment for late deep prosthesis-related infections and in all cases of septic loosening. However, there is no consensus about the optimal interval between the 2 stages. Patients and methods - We retrospectively studied 120 deep infections of total hip (n = 95) and knee (n = 25) prostheses that had occurred over a period of 25 years. The mean follow-up time was 5 (2-20) years. All infections had been treated with extraction, 1 or more debridements with systemic antibiotics, and implantation of gentamicin-PMMA beads. There had been different time intervals between extraction and reimplantation: median 14 (11-47) days for short-term treatment with uninterrupted hospital stay, and 7 (3-22) months for long-term treatment with temporary discharge. We analyzed the outcome regarding resolution of the infection and clinical results. Results - 88% (105/120) of the infections healed, with no difference in healing rate between short- and long-term treatment. 82 prostheses were reimplanted. In the most recent decade, we treated patients more often with a long-term treatment but reduced the length of time between the extraction and the reimplantation. More reimplantations were performed in long-term treatments than in short-term treatments, despite more having difficult-to-treat infections with worse soft-tissue condition. Interpretation - Patient, wound, and infection considerations resulted in an individualized treatment with different intervals between stages. The 2-stage revision treatment in combination with local gentamicin-PMMA beads gave good results even with difficult prosthesis infections and gentamicin-resistant bacteria.
authors.affiliation: a Department of Orthopedic Surgery , Research School CAPHRI, Maastricht University Medical Centre , Maastricht , the Netherlands.
authors.forename: Daniël M C
authors.initials: DM
authors.lastname: Janssen
authors.affiliation: a Department of Orthopedic Surgery , Research School CAPHRI, Maastricht University Medical Centre , Maastricht , the Netherlands.
authors.forename: Jan A P
authors.initials: JA
authors.lastname: Geurts
authors.affiliation: a Department of Orthopedic Surgery , Research School CAPHRI, Maastricht University Medical Centre , Maastricht , the Netherlands.
authors.forename: Liesbeth M C
authors.initials: LM
authors.lastname: Jütten
authors.affiliation: a Department of Orthopedic Surgery , Research School CAPHRI, Maastricht University Medical Centre , Maastricht , the Netherlands.
authors.forename: Geert H I M
authors.initials: GH
authors.lastname: Walenkamp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005839:Gentamicins / Q000008:administration & dosage*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D019904:Polymethyl Methacrylate
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