What is 1-Stage Revision Arthroplasty?
1-stage revision arthroplasty, also known as single-stage revision arthroplasty, is a surgical procedure used to treat infected joint replacements, typically in the hip or knee. This approach aims to address infection and replace the infected prosthesis in a single surgical session, contrasting with the traditional two-stage revision that involves an initial surgery to remove the infected prosthesis and place an antibiotic spacer, followed by a second surgery to implant a new prosthesis after the infection is cleared.
Indications for 1-Stage Revision Arthroplasty
1-stage revision arthroplasty is typically indicated for acute or chronic periprosthetic joint infections (PJIs) or other complications associated with joint prostheses, such as hip or knee replacements.
In general, the orthopedic surgeon may recommend 1-stage revision arthroplasty if:
- The patient's general health status allows for a single surgical session.
- The surgeon deems that the infection can be effectively managed in one stage.
- The infection around the joint is well-defined and contained.
- The soft tissue condition around the joint is satisfactory and capable of supporting the new prosthesis and healing after surgery.
- There is no major bone loss that would compromise the stability of the new implant.
Preparation for 1-Stage Revision Arthroplasty
In general, preparation for 1-stage revision arthroplasty may involve the following steps:
- A comprehensive medical evaluation, including physical examination, medical history review, allergies, medications/supplements, blood tests, and imaging studies to assess the condition of the infection and joint prostheses.
- Identification of the causative organism(s) through preoperative joint aspiration and culture.
- Initiation of appropriate antibiotic therapy based on culture results. Preoperative antibiotics are adjusted to target the identified pathogens.
- Instructions on avoiding certain medications and supplements that can thin the blood and increase the risk of bleeding during surgery.
- Instructions on fasting before surgery, stopping smoking, and limiting alcohol consumption.
Procedure for 1-Stage Revision Arthroplasty
In general, the procedure for 1-stage revision arthroplasty may involve the following steps:
- The patient is placed under general or regional anesthesia.
- An incision is made over the affected joint, and the joint is exposed.
- The existing prosthetic components are carefully removed. Special attention is given to avoid contamination of the surrounding tissues during removal.
- Extensive debridement of the joint is performed, removing all infected and necrotic tissues. Bone surfaces are thoroughly cleaned, and any remaining cement or debris from the previous prosthesis is removed.
- Multiple tissue samples are taken from different areas of the joint for culture and sensitivity testing.
- The joint is irrigated with copious amounts of antibiotic solution to reduce the bacterial load. Pulsatile lavage systems may be used for more effective irrigation.
- A new prosthesis is implanted. Depending on the specific case, either a cemented or cementless prosthesis may be used. If a cemented prosthesis is chosen, antibiotic-loaded bone cement is often used to provide local antibiotic release.
- Intraoperative imaging such as fluoroscopy may be used to confirm correct positioning.
- Finally, the surgical wound is closed in layers, and a sterile dressing is applied.
Postoperative Care and Recovery
In general, postoperative care and recovery for 1-stage revision arthroplasty may include:
- The patient will be transferred to the recovery room where the patient’s vital signs, such as oxygen saturation and blood pressure, are closely monitored as they wake up from anesthesia.
- Postoperative intravenous antibiotics are administered, typically for 4-6 weeks, followed by oral antibiotics for a total duration determined by the infectious disease specialist.
- It is common to experience pain and swelling around the treatment area. Medications are provided as needed to address these.
- Early mobilization and physical therapy are initiated to promote functional recovery and prevent complications such as joint stiffness or muscle atrophy.
- Regular follow-up visits are scheduled to monitor the patient's progress, assess the joint function, and ensure the infection has been eradicated.
Risks and Complications
Risks and complications associated with 1-stage revision arthroplasty include:
- Infection recurrence
- Antibiotic resistance
- Wound healing issues
- Prosthesis stability
- Damage to surrounding tissues
- Adverse reactions to anesthesia
- Thromboembolism or blood clots
Benefits
Advantages of 1-stage revision arthroplasty include:
- Single surgical event
- Reduced overall treatment time compared to two-stage revision
- Lower overall healthcare costs due to fewer surgeries and hospital stays
- Potential for quicker functional recovery and return to normal activities