This 2014 JAAOS review covers the North American standard of care for chronic periprosthetic hip and knee infection: two-stage revision arthroplasty. It addresses three contested areas — how to confirm infection eradication before reimplantation, which spacer design to use between stages, and how long to administer antibiotics.
When planning second-stage reimplantation, don't rely on ESR/CRP normalization to clear a patient — use synovial WBC (>3,000 cells/mL flags persistent infection in hips) and intraoperative frozen section, then proceed even with mildly elevated serology if the clinical picture supports it.
When you see poor soft-tissue envelope or prior spacer failure at the knee, downgrade to a static spacer; otherwise default to a mobile construct to preserve ROM and simplify your second stage.
This 2014 JAAOS review covers the North American standard of care for chronic periprosthetic hip and knee infection: two-stage revision arthroplasty. It addresses three contested areas — how to confirm infection eradication before reimplantation, which spacer design to use between stages, and how long to administer antibiotics.
When planning second-stage reimplantation, don't rely on ESR/CRP normalization to clear a patient — use synovial WBC (>3,000 cells/mL flags persistent infection in hips) and intraoperative frozen section, then proceed even with mildly elevated serology if the clinical picture supports it.
When you see poor soft-tissue envelope or prior spacer failure at the knee, downgrade to a static spacer; otherwise default to a mobile construct to preserve ROM and simplify your second stage.