Two-stage uncemented revision hip arthroplasty for infection

Abstract

We treated 50 consecutive patients with infected total hip arthroplasties according to a standard protocol. Previous surgery to eradicate the infection had been attempted in 13 patients and discharging sinuses were present in 20. Aspiration arthrography was routinely carried out before our interventions.The first stage was a meticulous removal of all foreign and potentially infected material. Samples were taken for culture and a thorough lavage carried out. Antibiotic-loaded beads were placed in the femoral shaft and an antibiotic-loaded cement ball in the acetabulum. At the second stage an uncemented arthroplasty was introduced. Bone allograft was used in 18 patients. The interval between procedures was usually three weeks, but this was extended if the wound was slow to heal or there was extensive bony destruction. Appropriate antibiotics were given for three months.At a mean follow-up of 5.8 years the rate of reinfection was 8% (4 patients). Two of these patients have had another, successful, two-stage revision. At this medium-term review, a satisfactory clinical and radiological outcome was obtained in all except two patients.

Similar outcomes between two-stage revisions for infection and aseptic hip revisions

“…Merle d'Aubigné and Postel score in the aseptic group was 12.5 points (5-18) and 13.1 points (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) in the septic group. Mean level of persisting pain was 0.7 in the aseptic group and 0.6 in the septic group (VAS; best 0, worst 10).…”

“…inlay, head) are changed during revision [4]. Two-stage revision using an antibiotic-loaded spacer is the favoured treatment option in a chronically infected situation, with a survival rate up to 91 % and an infection eradication rate between 85 % and 100 % [1,[5][6][7][8][9][10][11]. Clinical and functional outcomes of aseptic revision surgery is reportedly higher than those following septic revisions and a higher complication rate in infected cases [9,12,13].…”

Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma

“…Mean time from initial injury to EPR was 34 (6-102) months, and median number of previous operations was two (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). All patients had sustained traumatic fractures of the proximal femur-four 31.A2.3, The ultimate failed internal fixation was a dynamic hip screw in three cases (Fig.…”

“…Limb shortening and the inevitable need for a walking aid mean that GEA may be poorly tolerated in the more active and demanding patient. The functional scores observed in patients undergoing GEA as a result of infected total hip replacements [5] is considerably less than that of patients following twostage revisions for infection [6]. Hip replacement for failed internal fixation of intertrochanteric fractures also demonstrates far better functional outcomes than would be expected following GEA [7]; reimplantation has also been shown to be functionally superior to GEA [8].…”

Replacement of infected knee and hip endoprostheses

“…Trotz der gu ten Ergebnisse in einzelnen Studien für den einzeitigen Wechsel wird der zwei zeitige Wechsel als "Goldstandard" für die Behandlung periprothetischer Infek tionen betrachtet [11,18,38,50,70,97] (. Abb.…”