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Published on: December 3, 2017
Two-Stage Revision Protocol in Multidrug Resistant Periprosthetic Infection Following Total Hip Arthroplasty Using a
George C Babis1, Vasileios I Sakellariou2, Panayiotis G Pantos3
12nd Orthopaedic Department, University of Athens Medical School, Konstantopouleio General Hospital Nea Ionia, Athens, Greece.
Abstract:
We retrospectively reviewed the medical records of 31 patients with periprosthetic hip infections attempting to evaluate the outcome of a two-stage revision protocol characterized by prolonged interim period (mean=9.2 months, range 8-12 months) prior to the final re-implantation. In 3 cases (9.6%) the 1st stage was repeated after a mean period of 12.3 weeks due to relapse of infection. Five spacer dislocations occurred, not affecting the final clinical outcome after reimplantation, as evaluated by the Harris Hip Score. No protrusions or additional acetabular bone loss was noticed. Our proposed protocol is a simple, safe, efficient and reproducible treatment approach that may be successfully utilized predominantly when dealing with multidrug resistant pathogens.
Insights
This study found a prolonged two-stage revision protocol effective for treating hip periprosthetic joint infections, even with multidrug-resistant bacteria. The approach demonstrated safety and reproducibility in patient outcomes.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Periprosthetic hip infections pose significant challenges in revision arthroplasty.
- Effective management strategies are crucial for limb salvage and patient quality of life.
Purpose of the Study:
- To evaluate the efficacy and safety of a two-stage revision protocol for hip periprosthetic joint infections.
- To assess the impact of a prolonged interim period on treatment outcomes.
Main Methods:
- Retrospective review of medical records for 31 patients with hip periprosthetic joint infections.
- Analysis of a two-stage revision protocol with a prolonged interim period (mean 9.2 months).
- Evaluation of clinical outcomes using the Harris Hip Score.
Main Results:
- A low rate of infection relapse (9.6%) required repeating the first stage.
- Five cases of spacer dislocation occurred but did not impact final reimplantation outcomes.
- No instances of hip protrusion or additional acetabular bone loss were observed.
Conclusions:
- The prolonged two-stage revision protocol is a safe, simple, and effective treatment for hip periprosthetic joint infections.
- This approach is particularly beneficial when managing infections caused by multidrug-resistant pathogens.
- The protocol demonstrates reproducibility and positive clinical outcomes post-reimplantation.
