El estándar de dos etapas en la revisión de reemplazo total de cadera / The two-stage standard in revision total hip replacement

The two-stage standard in revision total hip replacement

1. H. J. Cooper, MD, Assistant Medical Staff, Adult Reconstructive Orthopaedic Surgery1; and
2. C. J. Della Valle, MD, Professor of Orthopaedic Surgery2

+ Author Affiliations

1. 1Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, New York 10075, USA .
2. 2Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300 Chicago, Illinois 60612, USA.

1. Correspondence should be sent to H. J. Cooper; e-mail:jcooper02@gmail.com

Abstract

Two-stage exchange remains the gold standard for treatment of peri-prosthetic joint infection after total hip replacement (THR). In the first stage, all components and associated cement if present are removed, an aggressive debridement is undertaken including a complete synovectomy, and an antibiotic-loaded cement spacer is put in place. Patients are then treated with six weeks of parenteral antibiotics, followed by an ‘antibiotic free period’ to help ensure the infection has been eradicated. If the clinical evaluation and serum inflammatory markers suggest the infection has resolved, then the second stage can be completed, which involves removal of the cement spacer, repeat debridement, and placement of a new THR.

Cite this article: Bone Joint J 2013;95-B, Supple A:84–7.

Resumen

Intercambio de dos etapas sigue siendo el estándar de oro para el tratamiento de la infección articular periprotésica después del reemplazo total de la cadera (THR). En la primera etapa, todos los componentes y cemento asociado si está presente se eliminan, un desbridamiento agresivo se lleva a cabo incluyendo una sinovectomía completa, y un antibiótico-cargado espaciador de cemento se ponen en su lugar. Los pacientes son tratados con seis semanas de antibióticos parenterales, seguido por un 'período libre de antibióticos "para ayudar a asegurar que la infección ha sido erradicada. Si la evaluación clínica y los marcadores inflamatorios séricos sugieren que la infección ha resuelto, a continuación, la segunda etapa se puede completar, que implica la eliminación del espaciador de cemento, desbridamiento de repetición, y la colocación de un nuevo THR.

Footnotes

• No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
  This paper is based on a study which was presented at the 29th Annual Winter 2012 Current Concepts in Joint Replacement® meeting held in Orlando, Florida, 12th – 15th December.

• Received September 7, 2013.
• Accepted September 8, 2013.

• ©2013 The British Editorial Society of Bone & Joint Surgery