Infection at the site of a total joint arthroplasty can be classified into four basic categories: Type I (early postoperative), Type II (late chronic), Type III (acute hematogenous), and Type IV (positive intraoperative cultures with clinically unapparent infection).
The current standard of care for late chronic infection is considered to be two-stage revision arthroplasty including removal of the prosthesis and cement, thorough débridement, placement of an antibiotic-impregnated cement spacer, a course of intravenous antibiotics, and a delayed second-stage revision arthroplasty.
The choice of the spacer, either articulating or nonarticulating, is based on many factors, including the amount of bone loss, the condition of the soft tissues, the need for joint motion, the availability of prefabricated spacers or molding methods, and antibiotic selection.
Current data have demonstrated that the use of antibiotic-impregnated cement spacers has improved the outcomes of the treatment of infection associated with total joint arthroplasty.
Total joint replacement is one of the most frequent and successful types of operations in orthopaedics. Infection is a rare yet devastating complication of the procedure, with a reported prevalence of 0.5% to 3% and with a higher reported prevalence after total knee arthroplasty than after total hip arthroplasty1-4. There is also a higher rate of infection after revision hip and knee arthroplasties than after primary hip and knee arthroplasties1-8.
Two-stage revision surgery was first described in 1983 by Insall et al., who demonstrated the necessity of removing the implants as well as the cement and of introducing antibiotic therapy for definitive treatment9. This procedure has emerged as the standard of care for a late chronic infection at the site of a total joint replacement4,5,10-17. Garvin and Hanssen reviewed twenty-nine studies and found that two-stage …
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