Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study.

Abstract

BACKGROUND:

Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol.

METHODS:

Nineteen patients (20 hips) were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS]) and hip joint function (Harris Hip score).

RESULTS:

The mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104) months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84) pre-operatively to 18 (range, 0 - 38) prior to spacer removal and to 8 (range, 0 - 15) at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment.

CONCLUSIONS:

Satisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.

• Authors: Carlo L Romanò, Delia Romanò, Enzo Meani, Nicola Logoluso, Lorenzo Drago
• Journal: BMC infectious diseases (BMC Infect Dis) Vol. 11 Pg. 129 (May 16 2011) ISSN: 1471-2334 [Electronic] England
• PMID: 21575241 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Arthritis, Infectious (surgery)
• Arthroplasty, Replacement, Hip (instrumentation)
• Cohort Studies
• Female
• Hip Injuries (surgery)
• Hip Joint (surgery)
• Hip Prosthesis
• Humans
• Male
• Middle Aged
• Prospective Studies
• Reoperation
• Treatment Outcome