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An Alternative One-Stage Exchange Arthroplasty Technique: For the Chronic Infected Total Hip
Keith Kotecki1, Victor Hoang1, Daniel LeCavalier1
1Orthopaedic Surgery, Valley Hospital Medical Center, Las Vegas, USA.
Cureus
|November 26, 2020
Summary
Single-stage exchange arthroplasty effectively treats chronic prosthetic joint infections (PJI) of the hip, offering a viable alternative to traditional two-stage procedures. This method achieved high infection eradication rates and implant retention in a small patient cohort.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomaterials Science
Background:
- Prosthetic joint infections (PJI) pose a significant challenge in orthopedic surgery.
- Two-stage hip exchange is the current standard for chronic hip PJI, but it involves considerable morbidity.
- One-stage exchange arthroplasty is emerging as a less invasive alternative, potentially reducing patient burden.
Purpose of the Study:
- To evaluate the efficacy and outcomes of a single-stage exchange arthroplasty technique for treating chronic hip PJI.
- To assess infection eradication rates, implant survival, and functional outcomes in patients undergoing this procedure.
Main Methods:
- A retrospective case series analyzed eight patients with chronic hip PJI treated between 2015 and 2020.
- All patients underwent a single-stage exchange hip arthroplasty using antibiotic-impregnated cement for both femoral and acetabular components.
- Diagnosis of PJI was based on the 2011 Musculoskeletal Infection Society (MSIS) criteria.
Main Results:
- Infection eradication was achieved in 75% of patients, with stable implants and no further surgery.
- One patient required closed reduction for dislocation but remained infection-free.
- One patient (the oldest) died postoperatively; 87.5% of living patients retained their implants.
Conclusions:
- Single-stage exchange arthroplasty using antibiotic-impregnated cemented components is a potentially effective treatment for chronic hip PJI.
- This technique can lead to successful infection eradication and preservation of function.
- Further validation through multi-center randomized trials is recommended.
