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Review
. 2018 Sep;11(3):420-427.
doi: 10.1007/s12178-018-9504-1.

Risk Factors and Treatment Options for Failure of a Two-Stage Exchange

Lorenzo Fagotti  1 , Jakub Tatka  1 , Mauro Jose Costa Salles  2 , Marcelo C Queiroz  3
Affiliations
Review

Risk Factors and Treatment Options for Failure of a Two-Stage Exchange

Lorenzo Fagotti et al. Curr Rev Musculoskelet Med. 2018 Sep.

Abstract

Purpose of review: Although a two-stage exchange revision is reported to have a high success rate, this strategy may fail as a treatment for prosthetic joint infection (PJI). When it does, resection arthroplasty, arthrodesis, amputation, and chronic antibiotic suppression may play a role. The purpose of this review is to determine which are the main risk factors for a two-stage exchange failure and to analyze the indications and results of resection arthroplasty, arthrodesis, amputation, and antibiotic chronic suppression for PJI.

Recent findings: Recent literature demonstrates that the main risk factors for a two-stage exchange failure are as follows: hemodialysis, obesity, multiple previous procedures, diabetes mellitus, corticosteroid therapy, hypoalbuminemia, immunosuppression, rheumatological conditions, coagulation disorders, and infection due to multidrug-resistant (MDR) bacteria or fungal species. Regarding microorganisms, besides Staphylococcus aureus, Streptococcus spp., Enterobacteriaceae species such as Klebsiella pneumoniae and Enterobacter sp., Pseudomonas aeruginosa, or Acinetobacter baumannii, and fungus including Candida sp. are also considered risk factors for a two-stage exchange failure. Resection arthroplasty, arthrodesis, and amputation have a limited role. Chronic suppression is an option for high-risk patients or unfeasible reconstruction. In summary, we report the main risk factors for a two-stage exchange failure and alternative procedures when it occurs. Future research on patient-specific risk factors for a two-stage exchange may aid surgical decision-making and optimization of outcomes.

Keywords: Chronic suppression therapy; Periprosthetic joint infection (PJI); Revision hip arthroplasty; Two-stage exchange arthroplasty; Two-stage infected exchange failure.

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Conflict of interest statement

Conflict of Interest

All authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
A 57-year-old female patient with rheumatoid arthritis and a right hip infected arthroplasty. The patient had three hip revisions and seven surgical debridement procedures with failure of eradication of infection. This patient had also two knee arthroplasty revisions. In face of a high chance of reconstruction failure and refusal of amputation, this patient was treated with chronic antibiotic suppression therapy
Fig. 2
Fig. 2
Same patient as in figure one with two active sinuses on the right thigh with purulent effusion. P proximal, M medial, D distal, L lateral
See this image and copyright information in PMC

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