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Current Reviews in Musculoskeletal Medicine
Published in: Current Reviews in Musculoskeletal Medicine 3/2018

01-09-2018 | Prosthetic Joint Infection (S Nodzo and N Frisch, section editors)

The Role of One-Stage Exchange for Prosthetic Joint Infection

Authors: Fiachra E. Rowan, Matthew J. Donaldson, Jurek R. Pietrzak, Fares S. Haddad

Published in: Current Reviews in Musculoskeletal Medicine | Issue 3/2018

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Abstract

Purpose of Review

In an era of increasing numbers of hip and knee replacements, strategies to manage prosthetic joint infection (PJI) that are effective at infection control with good patient-reported outcomes and cost containment for health systems are needed. Interest in single-stage exchange for PJI is rising and we assess evidence from the last 5 years related to this treatment strategy.

Recent Findings

Only five series for total knee replacement and ten series for total hip replacement have been reported in the last five years. More review articles and opinion pieces have been written. Reinfection rates in these recent studies range from 0 to 65%, but a meta-analysis and systematic review of all studies showed a reinfection rate of 7.6% (95% CI 3.4–13.1) and 8.8% (95% CI 7.2–10.6) for single-stage and two-stage revisions respectively. There is emerging evidence to support single-stage revision in the setting of significant bony deficiency and atypical PJIs such as fungal infections.

Summary

Prospective randomised studies are recruiting and are necessary to guide the direction of single-stage revision selection criteria. The onus of surgical excellence in mechanical removal of implants, necrotic tissue, and biofilms lies with the arthroplasty surgeon and must remain the cornerstone of treatment. Single-stage revision may be considered the first-line treatment for all PJIs unless the organism is unknown, the patient is systemically septic, or there is a poor tissue envelope.
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Metadata
Title
The Role of One-Stage Exchange for Prosthetic Joint Infection
Authors
Fiachra E. Rowan
Matthew J. Donaldson
Jurek R. Pietrzak
Fares S. Haddad
Publication date
01-09-2018
Publisher
Springer US
Published in
Current Reviews in Musculoskeletal Medicine / Issue 3/2018
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-018-9499-7

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