Abstract
Purpose
We hypothesized that a routine one-stage exchange for treatment of chronically infected total hip replacement (THR) will lead to (1) a higher rate of infection recurrence and (2) a poorer hip outcome than the published rates after two-stage exchange.
Methods
Sixty-five cases have been treated consecutively with one-stage exchange. All patients have been followed for a period of three to six years or until death or infection recurrence.
Results
The five-year rate for infection recurrence was 16 %. The five-year survival rate for recurrence of the index infection was 8 %. Forty-two percent of the hips had a good or excellent PMA score, and 46 % a good or excellent OH score.
Conclusions
Routine one-stage exchange was not associated with a higher recurrence rate and a poorer hip function than previously published series of two-stage exchange. Therefore, there is little support to choose two-stage exchange as the routine treatment for management of chronically infected THR.
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References
Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 95-B:1450–1452. doi:10.1302/0301-620×.95B11.33135
Cooper HJ, Della Valle CJ (2013) The two-stage standard in revision total hip replacement. Bone Joint J 95-B (11 Suppl A):84–87. doi:10.1302/0301-620 × .95B11.32906
Buchholz HW, Elson RA, Engelbrecht E, Lodenkämper H, Röttger J, Siegel A (1981) Management of deep infection of total hip replacement. J Bone Joint Surg 63-B:342–353
Parvizi J, Ghanem E, Azzam K, Davis E, Jaberi F, Hozack W (2008) Periprosthetic infection: are current treatment strategies adequate? Acta Orthop Belg 8:793–800
Klouche S, Leonard P, Zeller V, Lhotellier L, Graff W, Leclerc P, Mamoudy P, Sariali E (2012) Infected total hip arthroplasty revision: one- or two-stage procedure? Orthop Traumatol Surg Res 98:144–150. doi:10.1016/j.otsr.2011.08.018
RM M d’A, Postel M (2009) The classic: functional results of hip arthroplasty with acrylic prosthesis. 1954. Clin Orthop Relat Res 467:7–27. doi:10.1007/s11999-008-0572-1
Dawson J, Fitzpatrick R, Carr A, Murray D (1996) Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg 78-B:185–190
Tsukayama DT, Estrada R, Gustilo RB (1996) Infection after total hip arthroplasty. A study of one hundred and six infections. J Bone Joint Surg 78-A:512–523
Wolf CE, Gu NY, Doctor JN, Manner PA, Leopold SS (2011) Comparison of one and two-stage revision of total hip arthroplasty complicated by infection. J Bone Joint Surg 93-A:631–639. doi:10.2106/JBJS.I.01256
Beswick AD, Elvers KT, Smith AJ, Gooberman-Hill R, Lovering A, Blom AW (2012) What is the evidence base to guide surgical treatment of infected hip prostheses? Systematic review of longitudinal studies in unselected patients. BMC Med 10:18. doi:10.1186/1741-7015-10-18
Hsieh PH, Chen LH, Chen CH, Lee MS, Yang WE, Shih CH (2004) Two-stage revision hip arthroplasty for infection with a custom-made, antibiotic-loaded, cement prosthesis as an interim spacer. Trauma 56:1247–1252
Hofmann AA, Goldberg TD, Tanner AM, Cook TM (2005) Ten-year experience using an articulating antibiotic cement hip spacer for the treatment of chronically infected total hip. J Arthroplasty 20:874–879
Kraay MJ, Goldberg VM, Fitzgerald SJ, Salata MJ (2005) Cementless two-staged total hip arthroplasty for deep periprosthetic infection. Clin Orthop Relat Res 441:243–249
Masri BA, Panagiotopoulos KP, Greidanus NV, Garbuz DS, Duncan CP (2007) Cementless two-stage exchange arthroplasty for infection after total hip arthroplasty. J Arthroplasty 22:72–78
Wimmer MD, Randau TM, Petersdorf S, Pagenstert GI, Weißkopf M, Wirtz DC, Gravius S (2013) Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections. Int Orthop 37:2271–2278. doi:10.1007/s00264-013-1995-1
Jackson WO, Schmalzried TP (2000) Limited role of direct exchange arthroplasty in the treatment of infected total hip replacements. Clin Orthop 381:101–105
Rudelli S, Uip D, Honda E, Lima ALLM (2008) One-stage revision of infected total hip arthroplasty with bone graft. J Arthroplasty 23:1165–1177. doi:10.1016/j.arth.2007.08.010
Winkler H, Stoiber A, Kaudela K, Winter F, Menschik F (2008) One stage uncemented revision of infected total hip replacement using cancellous allograft bone impregnated with antibiotics. J Bone Joint Surg 90-B:1580–1584. doi:10.1302/0301-620×.90B12.20742
Yoo JJ, Kwon YS, Koo KH, Yoon KS, Kim YM, Kim HJ (2009) One-stage cementless revision arthroplasty for infected hip replacements. Int Orthop 33:1195–1201. doi:10.1007/s00264-008-0640-x
Oussedik SI, Dodd MB, Haddad FD (2010) Outcomes of revision total hip arthroplasty for infection after grading according to a standard protocol. J Bone Joint Surg 92-B:1222–1226. doi:10.1302/0301-620×.92B9.23663
Senthi S, Munro JT, Pitto RP (2011) Infection in total hip replacement: meta-analysis. Int Orthop 35:253–260. doi:10.1007/s00264-010-1144-z
Fleck EE, Spangehl MJ, Rapuri VR, Beauchamp CP (2011) An articulating antibiotic spacer controls infection and improves pain and function in a degenerative septic hip. Clin Orthop Relat Res 469:3055–3064. doi:10.1007/s11999-011-1903-1
De Man FH, Sendi P, Zimmerli W, Maurer TB, Ochsner PE, Ilchmann T (2011) Infectiological, functional, and radiographic outcome after revision for prosthetic hip infection according to a strict algorithm. Acta Orthop 82:27–34. doi:10.3109/17453674.2010.548025
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Jenny, JY., Lengert, R., Diesinger, Y. et al. Routine one-stage exchange for chronic infection after total hip replacement. International Orthopaedics (SICOT) 38, 2477–2481 (2014). https://doi.org/10.1007/s00264-014-2466-z
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DOI: https://doi.org/10.1007/s00264-014-2466-z