Introduction: Revision surgery in periprosthetic infection often encounters defects in bone stock caused by the loosening procedures, through continuous revisions or by explantation techniques. Since bony reconstruction in the presence of infection is critical, if no antibiotic impregnated bone grafts are available, metal implants are the last resort. Lately tantalum wedges and cones have been introduced as a stable augmentation device.

Material and Methods: Since 2007 we have used 14 tantalum implants to fill bone defects in 13 cases of severe purulent periprosthetic infection (4 cones, 10 wedges). All patients are in permanent control on an outpatient basis.

Results: Primary and continuous stability was achieved in all patients and no signs of recurrent or persistent infection were found.

Conclusion: So far this concept proves to be successful and can be recommended. The stability of the implant is recorded for numerous aseptic reconstructions. Research is needed towards the surface properties of tantalum in contact with bacteria. Positive findings like in silver coating would be desirable. Further research towards impregnation possibilities of the porous structure with antibiotics for continuous elution like from cement or fleece could – in a positive result – improve septic surgery substantially.

Introduction: One stage and two stage exchange procedures are acknowledged as gold standard for revision surgery in periprosthetic infection. Since the one stage concept is ethically, medically and economically superior, the last necessary argument is a fair rate of success on a large scale. The two stage procedure could then be limited to its genuine indications only.

Material and Methods: In three years (2005/06/07) 555 one stage exchanges of the hip and the knee were carried out at our clinic. A first homogenous group of 282 cases has now been analysed and followed-up. Detailed data regarding case history, clinical situation, treatment course and complications will be presented. All cases were investigated through a telephone protocol or examination on an outpatient basis by the same person. The group contained 180 hips and 102 knees. The median age was 68, (22/91). The median follow-up time was 31 months, (51/15).

Results: The primary success rate (dismissal from hospital) was 99% (1 death, 1 disarticulation). The revised rate of success in the course of the follow-up was 92,7 %.

Conclusion: With a success rate of 92,7 % this example of the one stage performance proves the standard realisation possibility of this concept. Advantages like no impairment in the interval without prosthesis, reduced complication and risk possibilities and reduced costs speak for this procedure. Nevertheless prerequisites have to be respected. But after all the one stage procedure should be made available to all patients with the appropriate indication.

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.

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.