Two-stage revision of prosthetic XXXX using antibiotic-loaded cement spacers: When is the best time to perform the second stage?

@entity1 @entity281 @entity697 @entity149
AIM: Managing @entity281 remains a challenging task, and adequate treatment strategies seem to be mandatory to avoid irreversible damage of the @entity149 . Two-stage revision arthroplasty includes removing all implants and subsequent implantation of an antibiotic-loaded cement spacer, followed by revision arthroplasty as the second stage. Although this procedure is well described in the literature, results remain unpredictable due to various clinical findings and the absence of prospective randomised trials. We analysed (1) mortality and (2) reinfection rates in a series of @entity1 who underwent two-stage revision surgery for periprosthetic @entity281 with antibiotic-augmented joint spacers. We maintained a special focus on the spacer retention period and its influence on outcome in order to determine the best time for second-stage surgery. @entity1 AND METHODS: A consecutive series of 76 @entity1 with native and periprosthetic @entity281 and who underwent two-stage revision surgery with antibiotic-loaded cement spacers were studied between 2005 and 2010. The second-stage operation was performed when it was assumed that @entity281 was eradicated. The further operative procedure depended upon intra-operative findings (frozen section, local status). RESULTS: Mean implant-free period with the antibiotic-loaded spacer in situ was 12.6  weeks. Spacer re-implantation was necessary in 13 cases due to positive signs of @entity697 in the frozen section and suspect intra-operative findings. Eight @entity1 were not operated for a second time in the investigated time period due to poor general condition. In 40 @entity1 , the spacer retention period was four to 11  weeks: <four  weeks for five and >11  weeks for 23. We observed a significantly higher proportion of @entity1 free from reinfection in the four to 11-week group than in @entity1 with the shorter or longer period. CONCLUSION: According to our findings, the optimal timing for second-stage surgery as a second-stage procedure is between four and 11 weeks. A significantly optimal reinfection rate was seen in @entity1 undergoing revision arthroplasty within that time frame, and 90  % of those @entity1 remained @entity281 free until final follow-up.
