TWO stage treatment of infected total knee and hip prostheses

The aim of this study is to determine the success rate of a two-stage revision arthroplasty performed by a single-surgical team and at a single-center, and to determine the factors that increase or decrease the rate of success. We evaluated patients who applied to Dokuz Eylul University, Faculty of Medicine, Orthopedics and Traumatology Clinic between April 2004 and May 2015 for periprosthetic knee and hip infection. Patients with at least two years of follow-up, with each stage of treatment conducted by a single surgical team, complete pre-operative and post-operative patients were included in the study. While patients with neurocognitive disorders such as Alzheimer's, dementia were excluded from the study. As a result, 138 of the 396 patients who underwent a two-stage revision arthroplasty were included in the study. A total of 138 patients and a total of 145 peripheral joint infections were examined. Of the 138 patients, 83 of them were knees and 55 were hips patients. A total of 88 knees and 57 hips periprosthetic joint infections were evaluated. In our study, two-stage revision arthroplasty was performed and patients that developed recurrent infection after the initial treatment were evaluated as failure. When two-stage revision arthroplasty joint infections were considered, 80% (116) were found to come from the external center. Active microorganisms were detected in 61.3% of the tissue samples taken during the operation. 298,5 days between debridement and revision arthroplasty operation in hip patients; where as the interval time between debridement and revision arthroplasty operation for knee patients was 214.5 days. The rate of success in two-stage revision arthroplasty as an infection eradication method was discovered to be 89.5% in hip patients and 85.2% in knee patients. A two-stage revision arthroplasty procedure with a single center and a single surgical team led to similar results has found in other literature. Correct application of two-stage revision arthroplasty therapy and infection eradication can be achieved with high success rate. Culture positivity was found to be 61.3% due to the fact that 80% of the patients were refered from other medical center and there was a history of antibiotic usage before the application. The culture positivity rate can be determined to be higher if single-centered management can be achieved from the first stage in the treatment process. Key words: Periprosthetic infection, two-stage revision, knee and hip revision