Risk Factors and Treatment Options for Failure of a Two-Stage Exchange View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2018-06-22

AUTHORS

Lorenzo Fagotti, Jakub Tatka, Mauro Jose Costa Salles, Marcelo C. Queiroz

ABSTRACT

Purpose of ReviewAlthough a two-stage exchange revision is reported to have a high success rate, this strategy may fail as a treatment for prosthetic joint infection (PJI). When it does, resection arthroplasty, arthrodesis, amputation, and chronic antibiotic suppression may play a role. The purpose of this review is to determine which are the main risk factors for a two-stage exchange failure and to analyze the indications and results of resection arthroplasty, arthrodesis, amputation, and antibiotic chronic suppression for PJI.Recent FindingsRecent literature demonstrates that the main risk factors for a two-stage exchange failure are as follows: hemodialysis, obesity, multiple previous procedures, diabetes mellitus, corticosteroid therapy, hypoalbuminemia, immunosuppression, rheumatological conditions, coagulation disorders, and infection due to multidrug-resistant (MDR) bacteria or fungal species. Regarding microorganisms, besides Staphylococcus aureus, Streptococcus spp., Enterobacteriaceae species such as Klebsiella pneumoniae and Enterobacter sp., Pseudomonas aeruginosa, or Acinetobacter baumannii, and fungus including Candida sp. are also considered risk factors for a two-stage exchange failure. Resection arthroplasty, arthrodesis, and amputation have a limited role. Chronic suppression is an option for high-risk patients or unfeasible reconstruction.SummaryIn summary, we report the main risk factors for a two-stage exchange failure and alternative procedures when it occurs. Future research on patient-specific risk factors for a two-stage exchange may aid surgical decision-making and optimization of outcomes. More... »

PAGES

420-427

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s12178-018-9504-1

DOI

http://dx.doi.org/10.1007/s12178-018-9504-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1105068035

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/29934884


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