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Clinical outcome in total hip arthroplasty for septic sequelae in childhood : a retrospective study
Rajesh Malhotra1, Sahil Batra1, PonAravindhan A Sugumar1
1Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India.
Insights
Total hip arthroplasty (THA) in adults with childhood hip infections yields excellent outcomes. This study found no reinfections and significant improvements in function and quality of life after THA.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Epidemiology
Background:
- Adults with a history of childhood hip infection present unique challenges for total hip arthroplasty (THA).
- These challenges include distorted anatomy, soft-tissue issues, reinfection risk, and younger patient age.
- Septic sequelae from childhood infections can complicate THA outcomes.
Purpose of the Study:
- To evaluate the clinical outcomes of cementless THA in patients with a history of childhood hip infection.
- To assess the rate of reinfection and complications following THA in this patient cohort.
- To determine the long-term functional results and quality of life after THA in patients with prior septic sequelae.
Main Methods:
- A retrospective analysis of 91 cementless THAs in patients with a history of childhood hip infection.
- Clinical outcomes were assessed using Harris Hip Score (HHS) and Modified Merle d'Aubigne and Postel (MAP) score.
- Quality of life (QOL) was measured using the SF-12 questionnaire, with limb length discrepancy (LLD) and radiological assessments also performed.
Main Results:
- Significant improvements were observed in HHS, MAP scores, and SF-12 scores (PCS and MCS) (p < 0.001).
- No cases of reinfection were reported during the follow-up period (mean 6.5 years).
- LLD decreased significantly, and revision-free survivorship was estimated at 100% at 5 years and 96.9% at 10 years.
Conclusions:
- Cementless THA provides good to excellent functional outcomes for patients with a history of childhood infection.
- The risk of reinfection after THA in these patients is exceedingly low.
- While complications can occur, THA is a viable option for improving function in this challenging patient group.
Aims:
Adult patients with history of childhood infection pose a surgical challenge for total hip arthroplasty (THA) due to distorted bony anatomy, soft-tissue contractures, risk of reinfection, and relatively younger age. Therefore, the purpose of the present study was to determine clinical outcome, reinfection rate, and complications in patients with septic sequelae after THA.
Methods:
A retrospective analysis was conducted of 91 cementless THAs (57 male and 34 female) performed between 2008 and 2017 in patients who had history of hip infection during childhood. Clinical outcome was measured using Harris Hip Score (HHS) and Modified Merle d'Aubigne and Postel (MAP) score, and quality of life (QOL) using 12-Item Short Form Health Survey Questionnaire (SF-12) components: Physical Component Score (PCS) and Mental Component Score (MCS); limb length discrepancy (LLD) and radiological assessment of the prosthesis was performed at the latest follow-up. Reinfection and revision surgery after THA for any reason was documented.
Results:
There was significant improvement in HHS, Modified Merle d'Aubigne Postel hip score, and QOL index SF 12-PCS and MCS (p < 0.001) and there was no case of reinfection reported during the follow-up. The minimum follow-up for the study was three years with a mean of 6.5 (SD 2.3; 3 to 12). LLD decreased from a mean of 3.3 cm (SD 1) to 0.9 cm (SD 0.8) during follow-up. One patient required revision surgery for femoral component loosening. Kaplan-Meier survival analysis estimated revision-free survivorship of 100% at the end of five years and 96.9% (95% confidence interval 79.8 to 99.6) at the end of ten years.
Conclusion:
We found that cementless THA results in good to excellent functional outcomes in patients with a prior history of childhood infection. There is an exceedingly low rate of risk of reinfection in these patients, even though complications are not uncommon. Cite this article: Bone Jt Open 2022;3(4):314-320.
