Introduction: Infections associated with prosthetic joints cause significant morbidity and account for substantial costs for health care systems. The management of prosthetic joint infections is less standardized, because of the variable clinical presentations and the lack of data from randomized, controlled trials.

We evaluated the results of surgical one stage versus two stage exchange of patients diagnosed positive for prosthetic infection following total hip replacement in correlation with a classification described by Mc Pherson.

Material and Methods: 94 patients were diagnosed positive for prosthetic joint infection following total hip replacement in the years 1995 to 2004: gender distribution was 45 male and 49 female patients. 37 patients were treated with a one stage exchange, 57 patients underwent a two step procedure. Patients were further divided into two groups following the mentioned classification described by Mc Pherson as infection type I+II and III. Further characterisation was performed following systemic host grade (A versus B+C) and local extremity grade 1 versus 2+3.

Results: Eradication of prosthetic infection was achieved in 94, 5% (n=52) within the group of two stage exchange and 56, 8% (n=21) of patients treated with a one stage procedure. Outcome of patients following a one stage or a two step exchange was overall significantly different with p< .001. Further deviations between the described two procedures were noted in the subgroups following the classification described by Mc Pherson. A benefit of patients who underwent a two step procedure was seen according the severity of the classification following Mc Pherson.

Conclusion: Eradication rate of prosthetic joint infections differs statistically significant overall and in the subgroups following Mc Pherson in dependence of the surgical procedure. For this reason the individual surgical procedure should be geared to an algorithm, following the classification described by Mc Pherson.

Introduction: Prosthetic joint infections occur in 1–2 % following total knee replacement. Different options of treatment are described in literature with a lack of data from randomized, controlled trials.

We classified septic revision surgeries following total knee according to a classification published by Mc Pherson. Eradication rate of one stage versus two stage exchange was compared.

Materials and Methods: We included 74 patients who underwent septic revision surgeries following total knee replacement in the years 1998 to 2005. Gender distribution was 42 female and 32 male patients. The mean age at revision surgery was 71 years, at primary implantation mean 68,8 years.

Results: The eradication rate overall was 77 %, in one stage exchange 41.7% and in two stage procedures 86%. Multiple stage revision showed an eradication rate of 75%, necrectomy/debridement 50%, arthrodesis and amputation 100%.

Regarding Mc Pherson’s systemic grades classification the eradication rate for two stage exchanges was 85,7% in group A+B and 60%% in group C. One stage procedures achieved 0% eradication rate in group B and 60% in group C. Regarding Mc Pherson’s local extremity grade classification eradication rates within two stage revisions were 84% in group 2 and 75% in group 3. One stage revision achieved 40% and 0%.

Conclusion: Although two stage revision surgeries achieved better results regarding eradication rates then one stage revision surgery, results were statistically not significant. Reason could be a too small number of included patients for a significant statistical impact. The individual surgical procedure should orientate on the classification published by Mc Pherson.

Introduction: Giant cell tumor of bone is a semimaligne tumor which locally recurs very often but rarely metastasises. En bloc resection of the distal radius with reconstruction using a homologeous allograft, curettage with PMMA blomb, and allograft arthrodesis are established methods. The aim of the study was to evaluate the functional outcome of our patients with the DASH-Score and the Mayo Wrist Score

Materials and Methods: In the last 7 years six patients were treated at our clinic due to a giant cell tumor of the distal radius. Two patients were primary treated with an en bloc resection. The other four were primary treated with curettage and filled up with PMMA cement plomb (Phenol was used in every case). In two of these cases a secondary en bloc resection was performed for local recurrence. For evaluation of function in daily live we used the DASH Score and the MAYO wrist score.

Results: The mean bone resection length was 5,25cm (5–6 cm).

All four patients treated with en bloc resection (primary or secondary) had no recurrence but in two out of that cases a re-operation was necessary because of non union.

At a mean follow up from 27 months (4–95) there were no recurrences or metastases at all

The flexion/extension of the wrist in currettaged radius was 60° and 80° compared with 38° and 68° in reconstructed radius. The pronation/suppination was 90°/90° in the currettaged ones versus 77°/77° in the allograft replaced ones.

The functional outcome evaluated with Mayo Wrist Score and DASH score showed an exellent outcome for both groups (84/7,7 Allograft < -> 85/10 Currettage)

Discussion: Functional outcome of distal radius resection reconstruction using an allograft is highly satisfactory compared with the literature, however we experienced a high risk for pseudoarthrosis. For prevention of non union simultan bone grafting at the index operation could be advisable.

The functional outcome proof no disadvantages in daily life and daily work compared to curettage. Thus allograft reconstruction of the distal radius represents a valuable alternative to arthrodesis.

Giant cell tumor of the distal radius is associated with a high local recurrence rate. En bloc resection of the distal radius and reconstruction using osteoarticular allograft, curettage with PMMA blomb, and allograft arthrodesis are established methods. The aim of the study was to evaluate the functional outcome of our patients with the DASH-Score and the Mayo Wrist score.

In the last 7 years six patients were treated at our department due to a giant cell tumor of the distal radius. Two patients were primary treated with an en bloc resection. The other four were primary treated with curettage packing of the defect with polymethylmethacrylate. In two of these cases a secondary en bloc resection was performed for local recurrence. For evaluation of function in daily live we used the DASH score and the MAYO wrist score.

The mean bone resection length was 5,25cm (5–6 cm).All four patients treated with en bloc resection (primary or secondary) had no recurrence but in two out of that cases a re-operation was necessary because of non union.

At a mean follow up from 27 months (4–95) there were no recurrences or metastases at all.

The flexion/extension of the wrist in currettaged radius was 60°/80° compared with 38°/68° in reconstructed radius. The pronation/suppination was 90°/90° in the currettaged ones versus 77°/77° in the allograft replaced ones.

The functional outcome evaluated with Mayo Wrist Score and DASH score showed an excellent outcome for both groups (84/7,7 Allograft < -> 85/10 Currettage)

Functional outcome of distal radius resection reconstruction using an allograft is highly satisfactory compared with the literature, however we experienced a high risk for pseudoarthrosis. For prevention of non union simultaneous bone grafting at the index operation could be advisable.

Thus allograft reconstruction of the distal radius represents a valuable alternative to arthrodesis.