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Clinical Orthopaedics and Related Research®

, Volume 467, Issue 7, pp 1848–1858 | Cite as

Two-stage Cementless Revision of Infected Hip Endoprostheses

  • Bernd FinkEmail author
  • Alexandra Grossmann
  • Martin Fuerst
  • Peter Schäfer
  • Lars Frommelt
Original Article

Abstract

Cementless two-stage revision of infected total hip prostheses lacks the possibility of local antibiotic protection of the implant at the time of reimplantation, which leads to the concern that this protocol may not sufficiently eradicate periprosthetic infection. Moreover, early implant loosening as much as 18% and stem subsidence as much as 30% have been reported. To determine whether a cementless revision could eradicate infection and achieve sufficient implant stability, we prospectively followed 36 patients with two-stage revisions for septic hip prostheses. We used a uniform protocol of a 6-week spacer interval, specific local and systemic antibiotic therapies, and cementless modular revision stems. The minimum followup was 24 months (mean, 35 months; range, 24–60 months). In one patient, the spacer was changed when the C-reactive protein value failed to normalize after 6 weeks, and the reimplantation was performed after an additional 6 weeks. No infections recurred. There was no implant loosening and a 94% bone-ingrowth fixation of stems. Subsidence occurred in two patients. The Harris hip score increased from a preoperative mean of 41 to 90 at 12 months after reimplantation and later. Using cementless prostheses in two-stage revisions of periprosthetic infections of the hip in combination with a specific local and systemic antibiotic therapy seems to eradicate infection and provide implant stability.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Keywords

Periprosthetic Infection Stem Subsidence Systemic Antibiotic Therapy Extended Trochanteric Osteotomy Fixation Zone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Bernd Fink
    • 1
    Email author
  • Alexandra Grossmann
    • 1
  • Martin Fuerst
    • 2
  • Peter Schäfer
    • 3
  • Lars Frommelt
    • 4
  1. 1.Department of Joint Replacement, General and Rheumatic OrthopaedicsOrthopaedic Clinic Markgröningen gGmbHMarkgröningenGermany
  2. 2.Orthopaedic Department, Rheumaklinik Bad BramstedtUniversity Hospital Hamburg-EppendorfBad BramstedtGermany
  3. 3.MVZ Labor LudwigsburgLudwigsburgGermany
  4. 4.Service for Infectious DiseasesClinical Microbiology and Infection ControlHamburgGermany

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