Two-stage revision for infection
Periprosthetic infection is one of the most serious complications of a prosthesis. Two-stage revision is a reference treatment and is different from an aseptic revision.
How is it diagnosed?
The diagnosis combines several elements: the symptoms (pain, redness, discharge or fever), blood tests that reflect inflammation and, above all, a joint aspiration to analyze the fluid and culture the organism.
Identifying the organism and its antibiotic sensitivity is key, because it guides both the antibiotic treatment and the surgical strategy.
For that reason, unless you are seriously unwell, antibiotics are not started before the samples are taken: doing so can turn the cultures negative and leave us without knowing which organism to treat. If you are already taking them, tell us —they are usually stopped about two weeks before the aspiration.
How does it work?
The infected prosthesis is removed, the joint is cleaned (debridement) and a cement spacer loaded with antibiotic is placed, which holds the space and releases antibiotic locally.
A targeted antibiotic course is completed over several weeks, together with infectious-disease specialists, confirming with tests that the infection resolves.
Once infection control is confirmed, the spacer is removed and a new revision prosthesis is implanted.
When is it chosen?
The strategy is decided according to the organism, the time course, the state of the tissues and of the patient. In very early or acute infections, with a well-fixed prosthesis, debridement with exchange of the mobile parts while keeping the implant can sometimes be enough. In some selected cases a single-stage exchange may be considered; in others, the two-stage approach offers the best chance of eradicating the infection.
What to expect during the process
Between the two operations the spacer allows some movement and, depending on the case, partial weight-bearing, though with limitations. It is a demanding, prolonged treatment that usually extends over several months until reimplantation.
The goal is to eradicate the infection and then recover a stable, functional joint. When the infection is controlled, the results of reimplantation are usually good, and patience during the interval is part of the treatment.
That is why it is worth getting in touch early: if a prosthesis that was doing well suddenly develops pain, redness, swelling, fever or discharge from the wound —especially after a dental, urinary or skin infection— let us know without waiting. When an infection is picked up very early and the prosthesis is well fixed, it can sometimes be resolved with a debridement that keeps the implant, an option that is lost with time.
Risks and considerations
- A prolonged treatment, with two operations and a period of limited mobility.
- Possibility of persistent or recurrent infection, which may require additional surgery.
- In a minority of cases the infection is not eradicated and salvage alternatives have to be considered —a new spacer, prolonged suppressive antibiotics, a fusion or, exceptionally, keeping the joint without reimplantation—, which are discussed if they become necessary.
- Effects of prolonged antibiotic treatment, monitored together with infectious-disease specialists.
- Bone loss and stiffness, which make reimplantation a complex revision surgery.
Shared decision-making
The decision to operate is made together: we discuss the organism and its sensitivities, the goals of treatment, the expected benefits, the risks and the alternatives. Surgery does not guarantee an outcome; it aims to eradicate the infection and then to restore a stable, functional joint.
This information is educational and does not replace a medical evaluation. Every case requires an individualized assessment and treatment, and no surgery guarantees an outcome.
Questions about your case?
Book an evaluation at RedSalud Vitacura or the Instituto Oncológico FALP.
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