Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection?

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management
• Biomaterials in Arthroplasty

Background:

• Methicillin-resistant hip infections are a growing clinical challenge.
• Existing two-stage total hip arthroplasty (THA) methods for these infections often use static spacers with variable success.
• Novel approaches are needed to improve infection control and patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of a two-stage THA employing an articulated cement spacer for methicillin-resistant hip infections.
• To determine the rate of successful infection control after this surgical approach.
• To assess patient functional outcomes and quality of life following treatment.

Main Methods:

• Retrospective review of 50 patients undergoing two-stage THA for methicillin-resistant Staphylococcus aureus or epidermidis hip infections.
• Analysis of 38 patients (after 12 deaths) with a minimum 24-month follow-up post-second stage.
• Collection of quality-of-life data using WOMAC, SF-12, Oxford-12, UCLA activity, and satisfaction scores.

Main Results:

• A 21% recurrence rate of infection was observed, necessitating further revision surgery.
• Among the remaining patients, functional scores were generally lower than those reported in prior literature.
• Mean WOMAC score was 62, Oxford-12 was 60, UCLA activity score was 4.3, and satisfaction score was 66.

Conclusions:

• The two-stage THA with an articulated cement spacer demonstrated a 21% treatment failure rate for methicillin-resistant hip infections.
• This failure rate is higher compared to studies including both resistant and non-resistant organisms.
• Functional outcomes in this cohort were suboptimal, highlighting the difficulty in managing these specific infections.