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Oper Orthop Traumatol. 2007 Mar;19(1):78-100.

Two-stage reimplantation with an application spacer and combined with delivery of antibiotics in the management of prosthetic joint infection.

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Orthopädische Abteilung, Diakoniekrankenhaus, Bad Kreuznach, Deutschland.



Management of a periprosthetic bacterial infection by two-stage revision of the prosthesis with implantation of an application spacer to maintain mobility and soft-tissue balance, and simultaneous delivery of antibiotics.


Periprosthetic infection, acute and chronic infection caused by a spectrum of pathogens that are often resistant to treatment. Chronic course with fistula formation. Imminent loss of mobility due to protracted immobilization after implant removal.


Relative: acute infection caused by a known spectrum of pathogens that can be brought under control by synovectomy and antibiotic treatment or by one-stage revision.


First, a complete synovectomy is performed, and the implant components and all foreign material are removed. The implant bed is then prepared for implantation of the application spacer for antibiotics. Silicone catheters are advanced through two separate drill holes into the intramedullary canal and then inserted into the perforated implant stems. After the application spacer for antibiotics has been implanted, the wound is closed.


Daily doses of antibiotics are delivered through the percutaneous silicone catheters directly into the intramedullary canal at the site of the infection. The application spacer for antibiotics allows daily physiotherapy and mobilization on a continuous passive motion device. Partial weight bearing may even be allowed, if there is sufficient stability. TWO-STAGE, DEFINITIVE MANAGEMENT: Definitive treatment by implantation of the prosthesis is performed once the CRP (C-reactive protein) values have decreased to normal levels.


36 patients have been treated with this method since 1992. A two-stage revision procedure on a total knee was performed in 20 patients, and revision of a total hip 16 times. The longest postoperative follow-up period is now 10 years. To date, none of the joints treated according to this method have required revision surgery. After 6.1 years, range of motion at the knee joint is 0/0/106 degrees (Hospital of Special Surgery [HSS Score] 79.5); after 6.3 years, range of motion at the hip is 10/0/110 degrees (Harris Score 81.3).

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