Two-stage hip revision arthroplasty for periprosthetic joint infection without the use of spacer or cemented implants

Abstract

Introduction

There is no gold standard for performing a two-stage exchange arthroplasty to treat periprosthetic joint infection (PJI). The use of spacers and the anchorage principles of the revision prosthesis remain controversial. Herein, we report the success rate of a two-stage total hip replacement procedure without using a spacer and only pressfit cementless implants.

Methods

Between 2009 and 2015, 57 patients with chronic late-onset PJI were treated using a two-stage prostheses exchange without spacer. The average age was 66.7 years (47–83 years). The mean follow-up was 53.9 ± 25 months. Treatment included microbiologic diagnostics and a high-efficiency antimicrobial therapy in between the operations for six weeks and a two week antibiotic-free interval before reimplantation of the cementless prostheses. After implantation, antibiotics were stopped. This study was approved by the institutional review board.

Results

Ninety-six percent of the patients had prior unsuccessful PJI treatment in other hospitals. The most common microorganism was Staphylococcus epidermidis (50.9%), followed by Propionibacterium acnes (17.5%) and Staphylococcus aureus (14%). In 42.1% cases, mixed infections were found. All patients could be treated using a cementless implant. In 91.2%, PJI remission was achieved, while 8.6% had chronic PJI with implant retention. Overall, nine prostheses (15.8%) were replaced owing to ongoing PJI or fractures. Mean modified Harris Hip Score was 60.85 (range: 22–88). None of the patients died.

Conclusion

We demonstrated a high success rate for two-stage exchange of infected total hip arthroplasty. Spacer-free treatment does not negatively affect success rate or function. Implantation of an uncemented pressfit prosthesis was possible in all patients.

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Correspondence to Yves Gramlich.

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Gramlich, Y., Hagebusch, P., Faul, P. et al. Two-stage hip revision arthroplasty for periprosthetic joint infection without the use of spacer or cemented implants. International Orthopaedics (SICOT) 43, 2457–2466 (2019). https://doi.org/10.1007/s00264-019-04297-y

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Keywords

  • PJI
  • Periprosthetic joint infection
  • Two-stage exchange
  • Cementless
  • Pressfit
  • Spacer