Gehrke et al. describe the Endo-Klinik's one-stage exchange protocol for prosthetic joint infection — its historical origins in Buchholz's antibiotic cement work in the 1970s, patient selection criteria, mandatory preoperative workup, surgical technique requirements, and postoperative management — and argue that current evidence does not establish two-stage exchange as superior.
When planning any revision TJA, get a joint aspiration with cultures held 14 days off antibiotics first — this paper's protocol shows 4–7% of "asymptomatic" revision cases are actually infected, and you cannot load cement appropriately without knowing your organism.
If aspiration returns a positive culture with a known antibiogram and the patient has no contraindications (neurovascular involvement, prior one-stage failures, resistant organism without available antibiotic), one-stage exchange with patient-specific antibiotic-loaded cement is a defensible alternative to two-stage with comparable published failure rates.
Gehrke et al. describe the Endo-Klinik's one-stage exchange protocol for prosthetic joint infection — its historical origins in Buchholz's antibiotic cement work in the 1970s, patient selection criteria, mandatory preoperative workup, surgical technique requirements, and postoperative management — and argue that current evidence does not establish two-stage exchange as superior.
When planning any revision TJA, get a joint aspiration with cultures held 14 days off antibiotics first — this paper's protocol shows 4–7% of "asymptomatic" revision cases are actually infected, and you cannot load cement appropriately without knowing your organism.
If aspiration returns a positive culture with a known antibiogram and the patient has no contraindications (neurovascular involvement, prior one-stage failures, resistant organism without available antibiotic), one-stage exchange with patient-specific antibiotic-loaded cement is a defensible alternative to two-stage with comparable published failure rates.