CORRInsights®: Single-stage Acetabular Revision During Two-stage THA Revision for Infection is Effective in Selected Patients

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Periprosthetic joint infection (PJI) occurs in approximately 1% of patients who undergo THA. The complication causes considerable morbidity for patients and the ideal treatment is still debated. Perhaps the best-accepted options are one- and two-stage revision.
Selective use of one-stage revision has the obvious advantages of avoiding a second major surgical procedure and the period of decreased mobility between the revision operations, but seems to perform better if the surgeon is able to isolate the infecting pathogen, and in most series has a lower likelihood of success than does two-stage revision [2, 8]. Another concern is that many single-stage series employed cemented stems to allow for local delivery of antibiotics, which may result in less-durable fixation over the longer run [10, 13].
Two-stage revision with an antibiotic-cement spacer should be considered the standard treatment because it is the more common approach, it's an established technique, and all new techniques are compared to it. Although articulating (mobile) cement hip spacers can cause mechanical complications including dislocation, spacer fracture, and further deterioration of already bone-deficient acetabuli, severe acetabular bone loss does not preclude a two-stage revision, and there are several well recognized solutions for such a problem including provisional cages, antibiotic-loaded cement shelves, and nonarticulating spacers [1, 4].
The technique presented by Fink and colleagues offers a new option—a compromise between two-stage and single-stage revision—for the management of some of the mechanical problems related to cement spacers in the face of severe acetabular deficiency. One concern with this option is that a portion of the definitive reconstruction is performed prior to confirming that the infection has been completely eradicated.
Alternative approaches, such as component retention of the femoral cement mantle in one- or two-stage procedures, have shown encouraging results [5-7, 9]. The apparent success of these case series contradict traditional teaching that safe reimplantation requires the removal of all foreign material followed by thorough débridement. Similarly, the technique described by Fink and colleagues is another “new thinking” option.
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