Two-stage hip revision arthroplasty: the role of the excision arthroplasty

  • Bergita Ganse
  • Peter Behrens
  • Jan Philipp Benthien
Original Article


Between 1995 and 2003, 41 septic hips in 40 consecutive patients (20 males, 20 females) were treated with a two-stage total-hip-arthroplasty revision. Seventeen patients with 18 relevant procedures (44%) were reviewed at a mean follow-up of 52 months. In 5 hips, an excision arthroplasty was present at review. Reimplantation had been performed in 13 hips. The interval between explantation and reimplantation averaged 158 days. The average age was 68 years and the mean ASA score 3.24 at explantation. Mean Harris Hip score was 60 points, the mean Mayo Hip Score 66 points. We found no significance (Harris Hip Score, t test) between results after reimplantation and with long-term excision arthroplasty. The excision arthroplasty as a long-term solution can be an alternative to reimplantation in the treatment of critically ill patients.


Two-stage hip arthroplasty revision Periprosthetic infection Infected total hip prosthesis Excision arthroplasty 

Reprise d’arthroplastie de hanche en deux temps:rôle de l’explantation simple


Entre 1995 et 2003, 41 hanches infectées correspondant à 40 patients consécutifs (20 hommes et 20 femmes) ont été traitées par révision d’arthroplastie en deux temps.17 patients avec 18 reprises pertinentes (44 %) ont été revus avec un recul moyen de 52 mois. Dans 5 hanches l’excision sans réimplantation existait au moment du contrôle. La réimplantation avait été réalisée dans 13 hanches. L’intervalle entre explantation et réimplantation était en moyenne de 158 jours. L’âge moyen était de 68 ans et le score ASA moyen de 3.24 lors de l’explantation. Le score de Harris moyen était de 60 points, le score de hanche Mayo moyen de 66 points. Nous n’avons pas noté de différence significative entre les résultats (Score de hanche de Harris, t-test) après réimplantation et ceux après explantation sans réimplantation à long terme. L’explantation sans réimplantation peut être une bonne alternative à la réimplantation chez des patients âgés à l’état général critique.

Mots clés

Arthroplastie de reprise en deux temps Infection péri-prothétique Prothèse de hanche infectée Arthroplastie sans réimplantation 


  1. 1.
    Bittar ES, Petty W (1982) Girdlestone arthroplasty for infected total hip arthroplasty. Clin Orthop Relat Res 170:83–87PubMedGoogle Scholar
  2. 2.
    Bourne RB, Hunter GA, Rorabeck CH, Macnab JJ (1984) A six-year follow-up of infected total hip replacements managed by Girdlestone’s arthroplasty. J Bone Joint Surg Br 66(3):340–343PubMedGoogle Scholar
  3. 3.
    Fehring TK, Calton TF, Griffin WL (1999) Cementless fixation in 2-stage reimplantation for periprosthetic sepsis. J Arthroplasty 14(2):175–181PubMedCrossRefGoogle Scholar
  4. 4.
    [No authors] (1982) The classic. Acute pyogenic arthritis of the hip: an operation giving free access and effective drainage. G. R. Girdlestone 1943. Clin Orthop Oct (170):3–7Google Scholar
  5. 5.
    Grauer JD, Amstutz HC, O’Carroll PF, Dorey FJ (1989) Resection arthroplasty of the hip. J Bone Joint Surg Am 71-A:669–678Google Scholar
  6. 6.
    Haddad FS, Muirhead-Allwood SK, Manktelow ARJ, Bacarese-Hamilton I (2000) Two-stage uncemented revision hip arthroplasty for infection. J Bone Joint Surg Br 82-B:689–694CrossRefGoogle Scholar
  7. 7.
    Hanssen AD, Osmon DR, Nelson CL (1996) Prevention of deep periprosthetic joint infection. J Bone Joint Surg Am 78-A:458–471Google Scholar
  8. 8.
    Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end-result study using a new method of result evaluation. J Bone Joint Surg Am 51-A:737–755Google Scholar
  9. 9.
    Ilyas I, Morgan DAF (2001) Massive structural allograft in revision of septic hip arthroplasty. Int Orthop 24(6):319–322PubMedCrossRefGoogle Scholar
  10. 10.
    Jenny J-Y, Jenny G, Lambert J, Gaudias J, Kempf I (1994) Gentamicin PMMA beads in management of bone and joint infections. Orthop Traumatol 4:101–104CrossRefGoogle Scholar
  11. 11.
    Karpaš K, Šponer P (2003) Management of the infected hip arthroplasty by two-stage reimplantation. Acta Medica (Hradec Králové) 46(3):113–115Google Scholar
  12. 12.
    Kavanagh BF, Fitzgerald RH Jr (1985) Clinical and roentgenographic assessment of total hip arthroplasty: a new hip score. Clin Orthop Relat Res 193:133–140PubMedGoogle Scholar
  13. 13.
    Liebermann JR, Callaway GH, Salvati EA, Pellicci PM, Brause BD (1994) Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol. Clin Orthop Relat Res 301:205–212Google Scholar
  14. 14.
    McElwaine JP, Colville J (1984) Excisional arthroplasty for infected total hip replacements. J Bone Joint Surg Br 66-B:168–171Google Scholar
  15. 15.
    Morscher E, Herzog R, Bapst R (1994) Hip revision surgery in septic loosening. Chir Organi Mov 79(4):335–340PubMedGoogle Scholar
  16. 16.
    Ridgeway S, Wilson J, Charlet A, Kafatos G, Pearson A, Coello R (2004) Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br 87-B:844–850Google Scholar
  17. 17.
    Rittmeister ME, Manthei L, Hailer NP (2005) Prosthetic replacement in secondary Girdlestone arthroplasty has an unpredictable outcome. Int Orthop 28(3):145–148CrossRefGoogle Scholar
  18. 18.
    Schröder J, Saris D, Besselaar PP, Marti RK (1998) Comparison of the results of the Girdlestone pseudarthrosis with reimplantation of a total hip replacement. Int Orthop 22:215–218PubMedCrossRefGoogle Scholar
  19. 19.
    Younger AS, Duncan CP, Masri BA, McGraw RW (1997) The outcome of two-stage arthroplasty using custom-made interval spacer to treat the infected hip. J Arthroplasty 12(6):615–623PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Bergita Ganse
    • 1
  • Peter Behrens
    • 2
  • Jan Philipp Benthien
    • 3
  1. 1.Department of Orthopaedic SurgeryUniversity of LübeckLübeckGermany
  2. 2.Orthopedikum HamburgHamburgGermany
  3. 3.Department of Orthopaedic SurgeryUniversity Hospital BaselBaselSwitzerland

Personalised recommendations