One-stage cementless revision arthroplasty for infected hip replacements

Abstract

We hypothesised that one-stage cementless revision hip arthroplasty may have advantages and a role in the treatment of selected patients with an infected hip replacement. We retrospectively reviewed all patients with an infected hip replacement treated with one-stage revision using cementless implants. Twelve patients were reviewed and followed up for at least three years (average: 7.2 years, range: 3.3-11.3 years) postoperatively. One recurrence of infection and one aseptic stem loosening were detected during followup. Grafted bone, which was used in eight patients, appeared to have united to host bone in all patients. The success rate of treatment was 83.3% when infection recurrence or component loosening were regarded as failure. One-stage revision hip arthroplasty using cementless implants appears to have a role in the treatment of carefully selected patients with an infected hip replacement if meticulous débridement is performed and appropriate antibiotics are properly used.Résumé Notre hypothèse de travail était la suivante: le changement en un temps par une prothèse sans ciment d'une prothèse totale de hanche infectée, est la bonne indication thérapeutique. Matériel et méthode: nous avons revu de façon rétrospective tous les patients présentant une hanche infectée traitée par une révision en un temps en utilisant un implant sans ciment. 12 patients ont été revus et suivis pendant au moins 3 ans (7,2 ans en moyenne, 3,3 et 11,3 ans postopératoire). Résultats: nous avons observé une récidive d'infection et un descellement aseptique durant cette période de suivi. L'os greffé chez 8 patients nous apparaît comme ayant consolidé à l'os hôte chez tous les patients. Le pourcentage de succès thérapeutique est de 83,3% si l'on regarde la récurrence de l'infection ou le descellement aseptique. En conclusion: les révisions en un temps en utilisant un implant sans ciment nous apparaissent comme un traitement de choix chez les patients sélectionnés avec soin et présentant une infection de prothèse totale de hanche.

The Modular Universal Tumour And Revision System (MUTARS®) in endoprosthetic revision surgery

“…If possible, a cementless fixation should be striven for. Clinical results that have been recorded so far are promising for the cementless revision (revision rates of 20% cemented vs. 7% cementless) [3,7,22,23].…”

Infection in total hip replacement: meta-analysis

“…Yoo et al [44] published a retrospective review of 12 patients treated with a variety of cementless implants. Eleven had type II infections.…”

Outcome of One-stage Cementless Exchange for Acute Postoperative Periprosthetic Hip Infection

“…To date, only one other study has reported outcomes after cementless single-stage exchange arthroplasty for periprosthetic hip infection: in a cohort of 12 patients with chronic PJI, Yoo et al [34] reported component retention in 10 of 12 patients at a mean followup of 7.2 years. However, they excluded all patients with PJI caused by MRSA.…”

“…However, several publications have demonstrated a failure rate, as defined as recurrent infection, component removal, or need for additional surgery resulting from infection, of 12% to 86% in series ranging from 20 to 138 patients [1,8,13,18,20,29]. In response to the unpredictability of this approach to control the infection, some have suggested a one-stage exchange arthroplasty as an alternative because it allows more thorough surgical débridement and removal of biofilm-colonized implants [2,4,16,34].…”

“…Several authors [6,33] have proposed cementless fixation for both primary and revision THA [6,33]. Currently, although there are some studies that support a one-stage exchange as a reasonable alternative for treating an acute postoperative infection [4,32,34], it is unclear whether a single-stage exchange arthroplasty for acute postoperative infection performed without antibiotic-laden bone cement will allow for component retention.…”