2-stage revision of 120 deep infected hip and knee prosthe-ses using gentamicin-PMMA beads

Background and purpose — A 2-stage revision is the most common treatment for late deep prosthesis-related infections and in all cases of septic loosening. However, there is no consensus about the optimal interval between the 2 stages. Patients and methods — We retrospectively studied 120 deep infections of total hip (n = 95) and knee (n = 25) prostheses that had occurred over a period of 25 years. The mean follow-up time was 5 (2–20) years. All infections had been treated with extrac- tion, 1 or more debridements with systemic antibiotics, and implantation of gentamicin-PMMA beads. There had been differ- ent time intervals between extraction and reimplantation: median 14 (11–47) days for short-term treatment with uninterrupted hos- pital stay, and 7 (3–22) months for long-term treatment with tem- porary discharge. We analyzed the outcome regarding resolution of the infection and clinical results. Results — 88% (105/120) of the infections healed, with no dif- ference in healing rate between short- and long-term treatment. 82 prostheses were reimplanted. In the most recent decade, we treated patients more often with a long-term treatment but reduced the length of time between the extraction and the reim- plantation. More reimplantations were performed in long-term treatments than in short-term treatments, despite more having diffi cult-to-treat infections with worse soft-tissue condition. Interpretation — Patient, wound, and infection consider- ations resulted in an individualized treatment with different intervals between stages. The 2-stage revision treatment in combination with local gentamicin-PMMA beads gave good results even with diffi cult prosthesis infections and gentamicin- resistant bacteria.