Partial implant retention in two-stage exchange for chronic infected total hip arthroplasty

The efficacy of partial retention of well-fixed components during two-stage exchange for chronic total hip arthroplasty (THA) infection has remained unknown.

A total of 14 patients with chronic infected THA were treated with damage control two-stage revision, including selective retention of the well-fixed femoral or acetabular component, aggressive debridement, antibiotic-laden cement spacer, antibiotic therapy, and delayed reimplantation. Indications for this treatment included chronic infected THAs with ingrown femoral or acetabular component and positive microbial growth with sensitive antibiotics. We excluded patients with acute infection; negative microbial growth; positive pathogen with high-virulence bacterial infections and multiple drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus, fungi, and Mycobacterium tuberculosis; sinus formation; a prior failure for periprosthetic joint infection (PJI) treatment; and obvious bone resorption in both femoral and acetabulum side. During the study period, this represented 3.3% (14/425) of the patients treated for infected THA. Minimum follow-up was three  years. None of the 14 patients in this series were lost to follow-up. Successful treatment was defined according to a modified Delphi-based international multidisciplinary consensus.

No repeated debridement and recurrence of infection occurred during the study period; no patient need chronic antibiotic suppression. Successful treatment of chronic PJI was achieved in all patients. Despite the high peri-operative complication rate, no severe consequences were observed. The mean Harris Hip Score was 86 (range, 82-92; SD, 3.3).

The selective partial implant retention two-stage revision for chronic PJI may be a treatment option in properly selected patients with low virulence bugs.