S05.KL4 SELECTION CRITERIAS FOR 1-STAGE EXCHANGE AND TWO STAGE EXCHANGE WITH AND WITHOUT SPACER IN INFECTED TOTAL HIP ARTHROPLASTY (ITHA)

Abstract

The Liestal algorithmus for the treatment of infected total joint arthroplasties proposes the abovementioned three groups for revisions with exchange.

One stage exchange is executed in the presence of a adequate soft tissue situation and in absence of bacteria difficult to treat.

Two stage revision with spacer and a interval of 2–3 weeks until re-implantation is indicated in bad soft tissue situations

Two stage revision without spacer, a curative intravenous antibiotic treatment period of 6 weeks, a break of 2 weeks followed by reimplantation is indicated in the presence of bacteria difficult to treat.

All patients of group 1 and 2 were treated with antibiotics for 3 months – the first two weeks intravenous.

The ones of group 3 only, if during reimplantation positive tissue cultures were harvested.

We analysed 72 episodes of ITHA, 22 with 1-stage exchange, 29 with 2-stage exchange with spacer, 21 with 2-stage exchange without spacer. All 16 cases but 1 with bacteria difficult to treat were included in the last group. In this presentation only cases are included following the algorithm completely as published. All patient had an overall treatment with antibioticsIn all patients the index operation was done more than two years prior to the latest control. Two patients died shortly after the operation, the result remaining unknown. Another 3 died between 1 and two years after the operation. They were regarded as probably cured. Only one case of group 2 suffered of a relapse being caused by a coagulase negative staphylococcus being resistant against Rifampin. 2-stage exchange without spacer was then successful. One case of reinfection with another bacterium happened in the group 1.

Conclusion: This analysis is indicating, that the presented algorithm allows positive results regarding elimination in around 95% of the cases. Better results may be provable when basing on a larger number of patients. It seems, that the selection of so called “easier cases” for 1-stage exchange does not lead to a higher number of relapses and helps for an overall more economic way of treatment.