Partial component-retained two-stage reconstruction for chronic infection after uncemented total hip arthroplasty: results of sixteen cases after five years of follow-up

Chen, Kun Hui; Tsai, Shi-Chun; Wu, Po Kuei; Chen, Cheng Fong; Wang, Hsin‐Yi; Chen, Wei Ming

doi:10.1007/s00264-017-3505-3

Cited by 26 publications

(34 citation statements)

References 25 publications

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“…Fourteen papers were initially selected, but only 6 were considered eligible for the study as they dealt strictly with the 2-stage approach in chronic PHI (Table 1). [6][7][8][9][10][11] The surgical procedure described in each paper was evaluated. The most frequently adopted techniques and practical tricks are summarized in the subsequent section.…”

Section: Resultsmentioning

confidence: 99%

“…There was a wide consensus regarding the surgical procedure. [6][7][8][9][10][11] In all main case series, the preoperative evaluation of patients consisted of serological analyses, a hip joint aspiration, and radiological assessment. The loose component was carefully assessed using serial X-rays and CT scans.…”

Section: Surgical Techniquementioning

confidence: 99%

“…In the first surgical stage, an accurate debridement, a synovectomy, and a modular part removal were performed. [6][7][8][9][10][11] Multiple tissue samples were retrieved to isolate the bacteria. The loose component was removed.…”

Section: Surgical Techniquementioning

confidence: 99%

“…The supposed well-fixed component was visually inspected and manually probed; in some cases, an invasive attempt to remove the stable component was performed with a dedicated instrumentation (Explant, Zimmer, Warsaw; USA). 7 If the component proved to be well-fixed, it was retained. Then the exposed metal parts were scrubbed and an aggressive lavage was performed.…”

Section: Surgical Techniquementioning

confidence: 99%

“…4,5 Thus, a partial 2-stage approach was developed to treat more complex cases, retaining the well-fixed components. [6][7][8][9][10][11][12]…”

Section: Introductionmentioning

confidence: 99%

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Partial 2-Stage Revision in Chronic Hip Arthroplasty Infections: A Review

et al. 2018

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Background: Periprosthetic hip infections (PHIs) are troublesome complications of hip arthroplasties. The gold standard procedure for treating chronic PHI is a 2-stage approach. Recently, however, more conservative approaches have been developed to spare the osseointegrated components and avoid sequestra, bone loss, devascularization, and difficult reconstructions. The partial two-stage approach, which leaves the well-fixed component in situ and removes the loosened component, may be an effective strategy. Objective: This paper, a narrative mini-review, analyzed the preliminary results of a partial 2-stage approach to treating chronic hip arthroplasty infections. Methods: Pertinent papers describing the partial 2-stage approach (leaving the well-fixed component in situ and removing the loosened component) were collected and evaluated. Results: Six main case series were selected. A total of 76 patients were included. Many patients were treated with socket removal and stem retention with quite similar surgical techniques. Many cases included highly virulent bacteria, and no pre-operative selection about comorbidities was performed. The first outcomes of this approach were promising, with a rate of infection control ranging from 81.3% to 100% at mid-term follow-up. Conclusion: This approach proved good at mid-term follow-up; however, many concerns still exist. In particular, the indications are imprecise, and the role of biofilm is still unclear. Despite the first good outcomes, the partial 2-stage approach for chronic PHI should be validated by multicenter prospective studies.

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