Chronic Periprosthetic Joint Infection: One-Stage Exchange

Besides the two-stage protocol, the one-stage exchange for treatment of periprosthetic joint infection is showing increasing popularity with good clinical results. The basis for a successful eradication of the infection is the diagnosis and especially the identification of the germ spectrum. Here, the diagnostic algorithm should be guided by the 2018 ICM criteria. Once the germ has been identified and local and systemic antibiotic therapy has been indicated by an interdisciplinary team, a one-stage revision surgery is possible. During surgery, strict attention must be paid to complete removal of implanted material and radical debridement with excision of infected tissue. Reimplantation is performed with the use of local antibiotic therapy using antibiotic-loaded polymethyl methacrylate (PMMA) bone cement. Systemic antibiotic therapy should generally last for at least 10–14 days. Compared to the two-stage exchange, the one-stage exchange shows comparable eradication rate with only one operation, therefore decreasing perioperative risks and providing higher patient satisfaction with the advantage of cost containment.