Acta Orthopaedica, 87:4, 324-332, DOI: 10.3109/17453674.2016.1142305

2-stage revision of 120 deep infected hip and knee prostheses using gentamicin-PMMA beads

Daniël M C Janssen, Jan A P Geurts, Liesbeth M C Jütten & Geert H I M Walenkamp
Hip Knee

Background and purpose — A 2-stage revision is the most common treatment for late deep prosthesis-related infections and in all cases of septic loosening. However, there is no consensus about the optimal interval between the 2 stages.

Patients and methods — We retrospectively studied 120 deep infections of total hip (n = 95) and knee (n = 25) prostheses that had occurred over a period of 25 years. The mean follow-up time was 5 (2–20) years. All infections had been treated with extraction, 1 or more debridements with systemic antibiotics, and implantation of gentamicin-PMMA beads. There had been different time intervals between extraction and reimplantation: median 14 (11–47) days for short-term treatment with uninterrupted hospital stay, and 7 (3–22) months for long-term treatment with temporary discharge. We analyzed the outcome regarding resolution of the infection and clinical results.

Results — 88% (105/120) of the infections healed, with no difference in healing rate between short- and long-term treatment. 82 prostheses were reimplanted. In the most recent decade, we treated patients more often with a long-term treatment but reduced the length of time between the extraction and the reimplantation. More reimplantations were performed in long-term treatments than in short-term treatments, despite more having difficult-to-treat infections with worse soft-tissue condition.

Interpretation — Patient, wound, and infection considerations resulted in an individualized treatment with different intervals between stages. The 2-stage revision treatment in combination with local gentamicin-PMMA beads gave good results even with difficult prosthesis infections and gentamicin-resistant bacteria.

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