Arthroplasty iSAWE 20

Question

An 86 year old man with a chronically infected total hip arthroplasty is between stages of revision.

Arthroplasty iSAWE 20, AP radiograph and coronal CT of the hip
AP radiograph and coronal CT of the hip. Image by Hellerhoff, Wikimedia Commons, CC BY-SA 4.0.
  1. What is shown and what is its purpose?
  2. Describe a two stage revision protocol.
  3. When is single stage revision suitable?

Answer

Imaging

  • Antibiotic loaded cement spacer in the hip after removal of the infected implant
  • Maintains soft tissue tension and leg length
  • Delivers local antibiotic
  • Allows limited mobilisation (articulating spacers)

Two stage protocol

  • Diagnosis using the ICM or EBJIS criteria
  • Remove all implants and cement, radical debridement
  • Five or more deep tissue samples for culture, stop antibiotics two weeks before if possible
  • Antibiotic loaded spacer with heat stable agents (vancomycin, gentamicin)
  • Targeted antibiotics for about 6 weeks
  • Reimplantation when the soft tissues have healed and inflammatory markers are falling
  • Repeat cultures at the second stage
  • Success rates about 85 to 90%

Single stage revision

  • Known organism with sensitivity to available antibiotics
  • Healthy soft tissue without a sinus
  • Immunocompetent host
  • Good bone stock
  • INFORM trial showed similar outcomes to two stage revision in selected patients

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.