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

被引：42
作者：
Fagotti L. [1 ]
Tatka J. [1 ]
Salles M.J.C. [2 ]
Queiroz M.C. [3 ]
机构：
[1] Steadman Philippon Research Institute, Vail, CO
[2] Division of Infectious Diseases, Department of Internal Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo
[3] Department of Orthopaedic Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo
来源：
Current Reviews in Musculoskeletal Medicine | 2018年 / 11卷 / 3期
关键词：
Chronic suppression therapy; Periprosthetic joint infection (PJI); Revision hip arthroplasty; Two-stage exchange arthroplasty; Two-stage infected exchange failure;
D O I：
10.1007/s12178-018-9504-1
中图分类号：
学科分类号：
摘要：
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. Summary: 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. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
引用
收藏
页码：420 / 427
页数：7
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