Aim: Revision of shoulder replacements in patients with irreparably damaged rotator cuffs and disintegrated coracoacromial arch are typical indications for the Delta-III-prosthesis. The aim of this study was to evaluate the results of one-stage exchange procedures with and without reconstruction of the glenoid (n =21) and compare them with the preoperative status.

Methods: Eighty-four patients who had undergone one-stage prosthesis exchange were included in the prospective analysis. Pain and functional results were recorded using our own specifically compiled follow-up questionnaire and evaluated according to the Constant/Murley Shoulder Score. The indications for exchange surgery were impingement and pain due to cranial dislocation of the prosthesis head in fifty-four cases, cranio-ventral dislocation in nineteen, periprosthetic infection in six, aseptic loosening in four, and postoperative ankylosis of the shoulder with heterotopic ossifications in one case.

Results: The mean age of the patients was 68.1 years (49–82). Prior to our exchange surgery sixteen patients had already undergone one and five patients two exchange procedures with implantation of a standard prosthesis. Thirty-eight patients had had several non-arthroplasty revision operations. After exchange for a Delta prosthesis eighty-three of the patients were pain-free or experienced tolerable pain only when the joint was subjected to a longer period of strain. The Constant/Murley Shoulder Score improved from a mean preoperative value of 27 to 58 points within 36–48 months. The overall complication rate was 13.1%. Bony reconstruction of the glenoid did not appear to have any significant influence on the outcome of the exchange procedure.

Conclusion: Patients’ satisfaction with the result of one-stage exchange of shoulder replacements using inverse implants is high due to the reliable and fast alleviation of pain, the satisfactory function of the joint and the fact that the need for nursing care can be avoided. The almost maximum functional result is already achieved after three months and with continued physiotherapy further gradual improvement is possible up to one year after surgery due to an increase in muscle strength. The outcome may be impaired by impingement at the lower glenoid rim leading to erosion and possible loosening of the component.

Limb salvage through total femur (TOFEM) prosthesis is a rare procedure. The infection rate is high due to the large implant surface, a long OR-time and often severely compromised soft tissues. In case of infection, the one-stage procedure is the way of revision to avoid impairing instability for the patient.

Between 1996 and 2005, 46 one-stage exchanges were performed in 37 patients. Twenty-three patients were available for review in 2006. Thirteen had died, 1 could not be located. The infection-free periods, subjective satisfaction with the procedure and clinical outcome were evaluated. The average follow-up time (FU) was 46 months (8/104). Male/female ratio was 10/27, and the average age 66 years. (30/87). The average number of revisions before the TOFEM was 5 (1/11).

Indication for a TOFEM was fracture in 43%, bone loss in 51% and others in 6%. Infection occurred at primary intervention in 32%, in connection with revisions in 18% or delayed in 49%.

Sixteen patients were cured through a one-step procedure with an average FU time of 46 months. Ten patients underwent further revisions. Two or more exchanges were carried out in 6 cases with success. Patients’ satisfaction rate was 55%. Thirteen were valued unsatisfied. Eight exarticulations became necessary later and 5 patients died in the course of the treatment. Two of those were exarticulated before.

The one-stage exchange is a promising procedure towards avoiding loss of the limb. A high complication rate exists and secondary exarticulation may still become necessary.

Introduction: Limb salvage through a total femur (TOFEM) prosthesis is a rare procedure. The infection rate is high due to the large implant surface, a long OR-time and often severely compromised soft tissues. In case of infection the one stage procedure is the way of revision to avoid impairing instability for the patient.

Material + Methods: Between 1996 and 2005 46 one stage exchanges were performed in 37 patients. 23 patients were available for review in 2006. 13 had died, 1 could not be located. The infection-free periods, subjective satisfaction with the procedure and clinical outcome were evaluated. The average follow-up time (FU) was 46 months (8/104). Male/female ratio 10/27, average age 66 yrs. (30/87). The average number of revisions before the TOFEM was 5 (1/11).

Indication for a TOFEM was fracture in 43%, bone loss in 51% and others in 6 %. Infection occurred at primary intervention in 32%, in connection with revisions in 18% or delayed in 49%.

Results: 16 Patients were cured in a one step procedure. 10 Patients underwent further revisions. Two or more exchanges were carried out in 6 cases with success. Patient’s satisfaction rate was 55%. 13 were valued unsatisfied. 8 exarticulations became necessary later and 5 Patients died in the course of the treatment. 2 of those were exarticulated before.

Conclusion: One stage exchange is a promising procedure avoiding loss of the limb. A high complication rate exists and secondary exarticulation may still become necessary.

Summary: The infectious complication in total femur prosthesesis presents a severe problem. A one stage revision offers another good chance for limb salvage, but morbidity and mortality risks are high.

Introduction: Periprosthetic infection is still the most severe complication in THA. In spite of vigorous efforts over the last decades the problem has not been solved nor minimized. Standardised procedures for prophylaxis and treatment have long been established. Reported results reach into the mid 80 % but did not improve remarkably in the last ten years. Our latest follow-up reveals a success rate of 87,5 %. A close analysis of the involved unsatisfying cases will help to improve future results.

Material + Methods: 105 consecutive one stage exchanges of THA for periprosthetic infection in 1996 were investigated after 7 years through questionnaire, telephone interview and clinical examination. An overall success rate of 87,5 % was found and the failures were analysed. Criteria like age, co morbidities, ASA, duration of infection anamnesis, number of infection related interventions, lab-findings, local findings like fistulas, x-ray rating, operation time, surgeon, complication postoperative and the bacteria involved were compared.

Results: In general it shows that the most desolate cases in all categories line up for a primary failure. The ASA rating is remarkably higher and local findings like fistulas are present in nearly all patients. The bacteria involved are staphylococci in 70 %. Over 50 % had a combination of two or more pathogens and two patients showed an additional pathogen in the samples taken during the operation. The pattern of the involved bacteria is remarkably severe. But there are also three cases where no sign of higher risk or lower chances could be detected.

Conclusions: Knowing about causes of failure in the specific one stage exchange situation does lead to adaptation in the concept of treatment for those specific cases. With successful application, better results through individual therapy-concepts will be possible.

Inverse shoulder prosthesis systems are available to compensate for irreparable dysfunction of the rotator cuff. The aim of this study is to evaluate the results after one-stage exchange operations of shoulder implants using the Delta Prosthesis and compare these with the preoperative status.

84 one-stage prosthesis exchanges were evaluated in this prospective analysis 0.5 to 4 years postoperatively. Symptoms of pain and functional results were recorded in a specially compiled follow-up questionnaire and also classified according the Constant and Murley shoulder score.

The mean age of the patients was 65.6 years (49–78 years). The current exchange operation was performed due to impingement caused by cranial migration of the implant head, cranio-ventral dislocation, periprosthetic infection, implant loosening and postoperative ankylosis of the shoulder joint. After the exchage operation with reimplantation of a Delta Prosthesis all patients had complete relief of pain or experienced tolerable pain. The function of the shoulder was markedly improved in all cases. The Constant and Murley shoulder score increased form the preoperative average of 29 to 58 points. The overall complication rate was 13.1%.

One-stage exchange of shoulder prostheses using inverse implants is a technically demanding, but standardised procedure for treating instability, dislocation, limited range of motion, loosening and infection in appropriate cases. The reliable reduction or complete elimination of pain has resulted in a high degree of satisfaction among patients. The final functional result is almost fully achieved as soon as three months postoperatively.

Introduction: Periprosthetic infection is still the most severe complication in THA. In spite of vigorous efforts over the last decades the problem has not been Solved nor minimized. Standardised procedures for prophylaxis and treatment have long been established. Reported results reach into the mid 80% but did not improve remarkably in the last ten years. Our latest follow-up reveals a success rate of 88.6%. A close analysis of the involved unsatisfying cases will help to improve future results.

Material and Methods: 105 consecutive one stage exchanges of THA for periprosthetic infection in 1996 were investigated after 7 years through questionnaire, telephone interview and clinical examination. An overall success rate of 88.6% was found and the failures were analysed. Criteria like age, co morbidities, ASA, duration of infection anamnesis, number of infection related interventions, lab-findings, local findings like fistulas, x-ray rating, operation time, surgeon, complication postoperative and the bacteria involved were compared.

Results: In general it shows that the most desolate cases in all categories line up for a primary failure. The ASA rating is remarkably higher and local findings like fistulas are present in nearly all patients. The bacteria involved are staphylococci in 70%. Over 50% had a combination of two or more pathogens and two patients showed an additional pathogen in the samples taken during the operation. The pattern of the involved bacteria is remarkably severe. But there are also three cases where no sign of higher risk or lower chances could be detected.

Conclusions: Knowing about causes of failure in the specific one stage exchange situation does lead to adaptation in the concept of treatment for those specific cases. With successful application, better results through individual therapy-concepts will be possible.