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Background One-stage revision arthroplasty has currently a limited use in treatment of a periprosthetic infection despite obvious economic benefits in comparison with two-stage revisions. This operation involves the removal of all implant components, radical surgical debridement, joint irrigation, installation of a new implant, and a long course of antibiotic therapy. Purpose To evaluate the effectiveness of one-stage revision arthroplasty in the treatment of patients with periprosthetic infection of the hip joint. Material and methods Results of treatment of 14 patients with periprosthetic hip infection who underwent the procedure of a single-stage revision arthroplasty in the period from 2009 to 2018 were analyzed. The average follow-up was 2.7 years (range, 1 to 10 years). Results Twelve (86 %) out of 14 patients with periprosthetic infection of the hip joint completed one-stage treatment successfully. Two (14 %) patients developed recurrent infection and had a two-stage revision arthroplasty using an antibacterial spacer. In accordance with the Harris Hip Score scale, the functional state of the limbs at a one-years follow-up after treatment averaged 77.7 points (range, 36 to 95). Conclusions One-stage revision is quite a laborious medical procedure, for which sufficient experience of orthopedic surgeons and a specialized hospital service. This method of treatment provided suppression of infection in 86 % of our cases. Negative factors in using one-stage revision were polymicrobial infection and implant dislocation in the early postoperative period.

Introduction The rate of complications after arthrodesis of the infected knee joint is 84 %, while the incidence of ankylosis failure varies from 17 % to 80 % thereby. At the same time, purulent process recurs in 50 % of cases, and, moreover, 73 % of patients report permanent pain after arthrodesis. Purpose of the study To evaluate long-term results of arthrodesis of the knee joint in patients with periprosthetic infection. Materials and methods Treatment results in 63 patients with periprosthetic infection of the knee joint who underwent arthrodesis using the Ilizarov apparatus in the period from 2005 to 2015 were assessed. The mean follow-up period was 8 ± 2.72 years (range, 3 to 13 years). There were 21 males (33 %) and 42 females (67 %). Mean age of patients was 59.05 ± 9.64 years (range, 29 to 80 years). Results Re-infection occurred in 17 (27 %) out of 63 patients with arthrodesis procedures of the knee joint with the use of the Ilizarov apparatus. It was established that the results of arthrodesis of the knee depend on the bone defect size. Conclusions Arthrodesis of the knee joint with the use of the Ilizarov apparatus in patients with periprosthetic infection enables to eradicate infection in 73 % of cases. Consolidation of fragments of the knee joint from the first attempt of arthrodesis was observed in 73 % of patients.

Introduction Two-stage revision arthroplasty is the "gold standard" of surgical treatment of periprosthetic infection in most domestic and foreign hospitals. This technique involves removal of implant components, debridement of the purulent focus and installation of a cement spacer which is subsequently replaced with a permanent implant after 3–9 months. Purpose To evaluate mid-term results of two-stage surgical treatment of patients with chronic periprosthetic infection of the knee and hip joints. Materials and methods Treatment outcomes of 172 patients with periprosthetic infection who underwent two-stage revision arthroplasty in the period from 2011 to 2015 were assessed. Among them, 113 patients developed infection after hip replacement and 59 patients had infected knee joint. The average follow-up period was 4 ± 1.58 years (range: 2 to 6 years). Results Out of 113 two-stage procedures of hip joint revision, 102 (90.2%) cases showed an arrest of infection. Four (3.6%) patients with recurrence of the purulent process underwent resection arthroplasty, another four (3.6%) rejected to replace the spacer with an implant, and three (2.6%) had a two-stage re-revision. Out of 60 (59 patients) procedures of a two-stage knee joint revision, infection was arrested in 50 (83.3%) cases; eight (13.4%) had recurrence and underwent knee arthrodesis. One (1.6 %) refused to replace a spacer for an implant, and one more (1.6%) had a two-stage repeated revision. Conclusions Two-stage knee and hip revision arthroplasty using a cement spacer is an effective option for treatment of chronic periprosthetic infection. It provides infection control in 86.7% (83.3% for knee and 90.2 % for hip joints) of cases in the mid-term follow-up period up to 5 years. However, the rate of re-infection remains significant and reaches 13.3 % (9.8% for hip and 16.7 % for knee joints).

Introduction Surgical treatment of acute periprosthetic infection is possible with the technique of debridement and replacement of only modular components of the implant, provided that the implant is stable. Positive outcomes by using this technique in the acute infection phase range between 85 and 100 % while in the chronic phase they the success range is only 0–50 %. This is explained by the ability of bacteria to form biofilms on metal and polyethylene implant surfaces. Material and methods We conducted the analysis of the treatment results in 35 patients with acute periprosthetic infection of the hip and knee joints. They all had joint debridement with replacement of the modular components of their implants. The implant elements removed were examined for the presence of biofilms and its pathogenic microorganisms. Results Laboratory methods of investigation revealed that irreversible biofilm types were found on the surface of the removed components of the implants in all patients if periprosthetic infection was manifested for more than 2 weeks. Arrest of the infectious process was achieved only in 10 patients (66.7 %) with knee pathology and in 11 patients (55 %) with infected hip joint area. Discussion The main cause of acute postoperative and hematogenic infection of joints is an isolated gram-positive microflora, which is observed in more than 50 % of cases. Irreversible biofilm types on the surface of the implant components in the patients with the duration of periprosthetic infection for more than 2 weeks explain the high rate of purulent process recurrence which reaches 33.3 % after debridement in infected knees and 45 % after debridement in the hip joints. Conclusion It seems worth reviewing the indications for the technique of debridement by which not all the elements of the implant are changed and reduce its use if infection lasts for more than 2 weeks. However, this assumption requires further study.