"I lost a leg prosthesis," I said.
Two-stage hip prosthesis for septic arthritis of the hip.
Based on data in the Norwegian Arthroplasty Register (NAR), we have compared the risk of re-revision after 4 different surgical procedures: 2-stage with exchange of the whole prosthesis, 1-stage with exchange of the whole prosthesis, major partial 1-stage with exchange of stem or cup, and minor partial 1-stage with exchange of femoral head and/or acetabular liner.
In one-stage revisions the prosthesis is exchanged in one operation.
One-stage revision ▸ In a one-stage revision, the infected prosthesis is removed, and the wound debrided (removing infected tissue) before a new replacement prosthesis is fitted, during the same procedure (ie, under the same anaesthetic) Two-stage revision ▸ In a two-stage revision, the replacement of the prosthesis is delayed, typically for 3 6 months while treating with antibiotics.
All patients underwent intra-operative sampling in multiple of infected material for microbiology and histology at the first stage (removal of infected prosthesis).
For patients with high-grade localized disease (Stage IIA/IIB), overall prosthesis survivorship remained greater than patient survival up to a critical time, at which point the rate of prosthetic failure became greater than patient survival.
One notable difference with our results is that most sonication fluid cultures of the spacer in the above cited study were discordant with the culture of both the prosthesis (first-stage surgery) and peri-prosthetic tissue specimens (second-stage surgery).
The remaining 784 infected THAs were revised in the following ways: 2-stage exchange of the whole prosthesis (n = 283), 1-stage exchange of the whole prosthesis (n = 192), major partial 1-stage exchange of the stem or the acetabulum (n = 129), or minor partial 1-stage with exchange of the femoral head and/or the acetabular liner only (n = 180) (Table 1 and Figure 1).
It is possible that the patients selected for one-stage revision or two-stage revision with mobile spacer prosthesis were healthier than those patients for whom two-stage revision was performed, for example, without any spacers.
The patient went onto fail the initial irrigation and debridement of the total knee arthroplasty at 4 weeks post-op which necessitated two-stage exchange of the prosthesis.
