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Hip-resection arthroplasty: A valuable treatment for complex hip prosthetic joint infection?
Lou Macaux1, Benjamin Levavasseur2, Younes Kerroumi2
1Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint-Simon, 125 rue d'Avron, 75020 Paris, France; Laboratoire des Centres de Santé et Hôpitaux Île-de-France, Groupe Hospitalier Diaconesses Croix Saint-Simon, 125 rue d'Avron, 75020 Paris, France.
Introduction:
Management of recurrent hip prosthetic joint infection (PJI) is challenging. Hip-resection arthroplasty is a last-choice rescue strategy for complex PJI. The main objective was to assess prospectively the mid-term infectious and functional PJI outcomes of patients managed with hip-resection arthroplasty.
Hypothesis:
In complex multi-operated PJI, hip-resection arthroplasty may cure the infection without any major impact on hip function, which is often already very limited.
Material And Methods:
This prospective cohort study conducted in a French Referral Center for bone-and-joint infections included all hip PJIs treated with hip-resection arthroplasty from 2004 to 2019. Patients were followed for at least 2 years, with recording of the following events: reinfection, including relapse or new infection, and PJI-related death. Hip functional status was assessed with the modified Merle d'Aubigné-Postel (mMAP) score. The primary outcome was 2-year event-free survival (EFS). The secondary outcomes were the 4- and 6-year EFS rates and hip functional status at 2 years.
Results:
We included 30 patients: median age, 65 years; 39% women. Median [IQR] PJI duration was 15 [4-39] months and patients underwent a median of 5 surgical procedures before resection arthroplasty. The 2-year reinfection free-survival was 89.2% (95% CI: 70.2-96.4). After a median follow-up of 70 [32-103] months, we observed: 1 relapse, 4 new infections, 7 revisions for mechanical reasons and 1 PJI-related death. Median mMAP score 2 years postsurgery was 12, versus 7 before; pain reduction was the main benefit of resection arthroplasty.
Discussion:
Hip-resection arthroplasty achieves sepsis and pain control, and can be a valuable last-line rescue strategy for patients with complex or recurrent hip PJIs.
Level Of Evidence:
II; monocentric prospective cohort.
Insights
Hip-resection arthroplasty effectively manages recurrent hip prosthetic joint infections (PJI), offering a valuable last-line treatment. This approach controls infection and reduces pain, improving function in complex cases.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Arthroplasty
Background:
- Recurrent hip prosthetic joint infection (PJI) presents significant management challenges.
- Hip-resection arthroplasty is a critical, albeit last-resort, intervention for complex PJI cases.
Purpose of the Study:
- To prospectively evaluate the mid-term infectious and functional outcomes of hip-resection arthroplasty in patients with hip PJI.
- To assess the efficacy of hip-resection arthroplasty as a salvage procedure for complex, multi-operated hip infections.
Main Methods:
- A prospective cohort study of 30 patients with hip PJI treated with hip-resection arthroplasty between 2004 and 2019.
- Follow-up included monitoring for reinfection and PJI-related death, with hip function assessed using the modified Merle d'Aubigné-Postel (mMAP) score.
- Primary outcome was 2-year event-free survival (EFS); secondary outcomes included 4- and 6-year EFS and functional status at 2 years.
Main Results:
- The 2-year event-free survival rate was 89.2%.
- After a median follow-up of 70 months, outcomes included 1 relapse, 4 new infections, 7 revisions for mechanical issues, and 1 PJI-related death.
- The median mMAP score improved from 7 to 12 at 2 years post-surgery, with pain reduction being the primary benefit.
Conclusions:
- Hip-resection arthroplasty is effective in achieving sepsis control and pain relief in patients with complex or recurrent hip PJI.
- This salvage procedure offers a valuable option for managing challenging hip prosthetic joint infections when other treatments have failed.
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