Description
Based on the first implementation of mixing antibiotics into bone cement by Prof. Buchholz in the 70`s, the ENDO-Klinik followed a distinct one staged exchange for PJI in over 85 % of all our infected cases until today. Looking carefully at current literature and guidelines for the PJI treatment, there is no clear evidence, that a two- staged procedure has a clearly higher success rate than a one-staged approach. Although postulated in relevant articles, most recommendations, e.g. duration of antibiotics, static vs. mobile spacer, interval of spacer retention, cemented vs. uncemented implant fixation, are based on level IV to III evidence studies or expert opinions, rather than on prospective randomized or comparative data. Potentially a cemented one-stage exchange offers certain advantages, as mainly based on need for only one operative procedure, reduced antibiotics & hospitalization time and reduced relative overall costs. In order to fulfill a one-staged approach with the above described potential success, there are obligatory pre-, peri- and postoperative details, which need to be meticulously respected. The absolute mandatory infrastructural requirement is based on the clear evidence of the bacteria in combination with a distinct patient specific plan, by an experienced microbiologist, for the following topic antibiotics in the bone cement with combined systemic antibiotics. The surgical success relies not only on the complete removal of all preexisting hardware material (including cement and restrictors), furthermore an aggressive and complete debridement of any infected soft tissues and bone material is needed. However a well-defined preoperative planning regime including an experienced microbiologist is absolutely mandatory.
