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Retention of the well-fixed implant in the single-stage exchange for chronic infected total hip arthroplasty: an average of five years of follow-up

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Abstract

Purpose

Removal of an infected prosthesis was considered the gold standard for eradication of infection. However, removal of well-fixed components can result in structural bone damage and compromised reconstruction. In these situations we questioned whether the infection after the total hip arthroplasty could be treated effectively and retain the well-fixed implant in a single-stage exchange.

Methods

A retrospective analysis which included 31 patients with chronic infected THA who underwent major partial single-stage revision, including routinely exchanged femoral head and liner components, aggressive soft tissue debridement, removal of the femoral stem or acetabular cup and retention of the well-fixed component, thorough exposed component brushing, and adequate surgical soaking. Powdered Vancomycin was poured into the surgical area and the infection control rate and clinical outcomes were evaluated. The failure to treat the infection was defined as a recurrence of infection in the same hip. The average follow-up was five years (2–15 years).

Result

There were four (12.9 %) failures during the study period at an average of 15 months (9–21 months) after partial single-stage revision. Of the 31 patients, 27 (87.1 %) patients had a satisfactory outcome and required no additional surgical or medical treatment for recurrence of infection. Acetabular cups were revised in 22 patients and femoral stems in nine patients. The mean post-operative Harris hip score at the most recent assessment was 74.6 (68–82).

Conclusions

Treatment of chronic infected THA with retention of the well-fixed implant in a single-stage exchange can be fairly effective in the treatment of infection and achieving acceptable functional outcomes, which indicated that this may be an attractive alternative in highly selected patients.

Level of Evidence: Level IV, therapeutic study.

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Acknowledgments

We thank LetPub for its linguistic assistance during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, 137 South LiYuShan Road, Urumqi, Xinjiang, 830054, China

    Baochao Ji, Boyong Xu, Wentao Guo, Aili Rehei, Wenbo Mu, Desheng Yang & Li Cao

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  1. Baochao Ji
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  2. Boyong Xu
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Correspondence to Li Cao.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Funding

Major Science and Technology Project of Xinjiang Uygur Autonomous Region (201430123–3).

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Ji, B., Xu, B., Guo, W. et al. Retention of the well-fixed implant in the single-stage exchange for chronic infected total hip arthroplasty: an average of five years of follow-up. International Orthopaedics (SICOT) 41, 901–909 (2017). https://doi.org/10.1007/s00264-016-3291-3

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  • DOI: https://doi.org/10.1007/s00264-016-3291-3

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