The one stage approach to revision TKAs

Thorsten Gehrke, MD
The two-stage exchange arthroplasty has become the golden standard worldwide, although the actual data yielded no clear evidence for superior results of the two-stage procedure. The ENDO-Klinik has established the one-stage procedure in the 1970´s. Since then, the ENDO-Klinik followed the one-staged approach in our clinic in over 85 % of all our periprosthetic joint infections.The main requirement to perform the one-stage exchange arthroplastyis the known germ with known susceptibility based on microbiological diagnostics. To achieve a successful one-stage procedure, diverse key points have to be fulfilled. The collaboration with a microbiologist is crucial to choose the ideal antibiotic loaded cement and the postoperative systemic antibiotic therapy. Furthermore, well-defined intra-hospital infrastructure and meticulous preoperative aspiration regime are essential. Moreover, radical debridement and removing of all hardware materials is mandatory and postoperative specific patient care plays an important role.

The successful one-stage exchange technique delivers certain advantages such as the need for only one operation, reduced systemic antibiotics, shorter hospitalization and overall lower costs. In this context, indications, surgical technique, advantages/disadvantages and clinical results of the one-staged exchange in infected PJI of the knee joint, which has been established 40 years ago in the HELIOS ENDO-Klinik Hamburg, is shown.