Two-stage exchange hip arthroplasty: Articulating spacers

Abstract

The incidence of primary total hip arthroplasty (THA) is estimated to increase 174 % to 552,000 procedures by the year 2030 and the demand for revision hip surgery may double by 2026 (J Bone Joint Surg Am 89(4):780-5, 2007). Periprosthetic joint infections (PJI) are estimated to occur in 1 % of primary THA and 4 % of revision THA procedures (J Bone Joint Surg Am 87(7):1487-97, 2005; Clin Orthop Relat Res 468(1):52-6, 2010). Thus, it can be extrapolated that the treatment of PJI will become much more common in the future (J Arthroplasty 5(8):1216-22e1-3, 2010). Once diagnosed, a chronic deep infection can be treated by one of several methods. Chronic suppression, irrigation and debridement, single-stage exchange, and two-stage exchange have all been described in the treatment of PJI (Clin Orthop Relat Res 369:139-43, 1999; J Bone Joint Surg Am 65(1):128-34, 1983; Orthop Clin North Am 24(4):761-7, 1993; J Arthroplasty 3(2):109-16, 1988; Clin Orthop Relat Res 414:55-60, 2003; J Bone Joint Surg Br. 1981;63-B(3):342-53; Clin Orthop Relat Res 211:103-7, 1986). Two-stage exchange is the generally accepted standard-of-care in North America (J Arthroplasty 19(6):768-74, 2004; J Arthroplasty 20(7):874-9, 2005; Clin Orthop Relat Res 2005;441:243-9; J Arthroplasty 2009;24(8):1264-9; J Arthroplasty 2007;22(1):72-8; Clin Orthop Relat Res 2009;467(1):219-24; J Bone Joint Surg Am 2011;93(7):631-9; J Bone Joint Surg Am 1998;80(1):60-9).