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Two-stage cementless revision THR after infection. 5 recurrences in 40 cases followed 2.5-7 years
1Department of Orthopedics, National Cheng Kung University Medical Center, Tainan, Taiwan.
Abstract:
We revised 40 infected hip prostheses in 40 patients as a two-stage procedure, including intravenous and oral antibiotics, gentamicin beads, and delayed cementless implantation of porous-coated THR. The duration of antibiotic treatment was 8 weeks. The interval from resection to reimplantation was, on average, 48 (8-108) weeks. 39 patients were followed, on average, 4 (2.5-7) years. 5 patients had a recurrent infection. In patients who did not have a recurrent infection, the Harris hip score exceeded 80 in 32 patients. Radiographically, femoral component migration of 2-6 mm was noted in 3 cases. The recurrent infection rate, and the functional and radiographic results are comparable with those obtained using a two-stage procedure with antibiotic cement.
Insights
This study revised 40 infected hip prostheses using a two-stage procedure with antibiotics and porous-coated total hip replacement (THR). Results show recurrent infection rates and outcomes comparable to antibiotic cement methods.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Management in Arthroplasty
- Biomaterials in Orthopedics
Background:
- Periprosthetic joint infection (PJI) following total hip replacement (THR) is a significant complication.
- Two-stage revision surgery is a common approach for managing infected THR.
- Comparing outcomes of cementless reimplantation with antibiotic-loaded cement is crucial for treatment optimization.
Purpose of the Study:
- To evaluate the efficacy of a two-stage revision procedure for infected hip prostheses using delayed cementless implantation.
- To assess the recurrent infection rate, functional outcomes (Harris hip score), and radiographic results.
- To compare these outcomes with traditional two-stage procedures utilizing antibiotic-loaded cement.
Main Methods:
- Retrospective review of 40 patients undergoing two-stage revision for infected hip prostheses.
- Treatment involved intravenous and oral antibiotics, gentamicin beads, and delayed cementless implantation of porous-coated THR.
- Antibiotic therapy duration was 8 weeks; average resection to reimplantation interval was 48 weeks.
Main Results:
- 39 patients were followed for an average of 4 years, with 5 experiencing recurrent infection.
- In patients without recurrent infection, 32 achieved a Harris hip score exceeding 80.
- Radiographic evaluation showed femoral component migration of 2-6 mm in 3 cases.
Conclusions:
- The two-stage revision procedure with delayed cementless implantation demonstrates comparable recurrent infection rates to antibiotic cement methods.
- Functional and radiographic outcomes are favorable and consistent with established two-stage protocols.
- This approach offers a viable alternative for managing infected hip prostheses.