It is widely believed that a deep implant infection leads to poor functional and emotional outcomes following total hip arthroplasty.
The purpose of this retrospective comparative review was to determine if patients who undergo two-stage, septic revision hip arthroplasty will have decreased emotional and general health scores, in addition to decreased function, compared to the aseptic revision group.
Patients and Methods
One hundred forty-five of 195 patients who underwent aseptic total hip revision for aseptic loosening (mean follow-up = 61 months) and 45 of 73 patients who underwent two-stage, septic revision hip arthroplasty (mean follow-up = 48 months) met the inclusion criteria and had a technically successful outcome. All patients were retrospectively evaluated using Harris Hip Scores (HHS), ad hoc questions, and the SF-36 Health Survey.
The average HHS were 73.2 ± 20.5 (aseptic) and 57.4 ± 20.6 (septic). Significant differences in the SF-36 Health Survey were found between the two groups in: physical functioning (p = 0.026) and role limitations due to physical health (p = 0.004). No significant difference in SF-36 scores was seen in: Energy/Fatigue, General Health Perception, Personal or Emotional Problems, Role Limitations due to Emotional Well Being, Social Functioning, and Bodily Pain.
Two-stage, septic revision produces a poor functional outcome compared to aseptic revision; however, the overall impact of a septic revision emotionally and socially was not significantly different than patients undergoing aseptic revision.
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Barrack RL, Engh G, Rorabeck C, Sawhney J, Woolfrey M. Patient Satisfaction and outcome after septic versus aseptic revision total knee arthroplasty. J Arthroplasty. 2000;15:990–993.
Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91:128–133.
Gallo J, Rozkydal Z, Sklensky M. Reconstruction of severe acetabular bone defects using Burch-Schneider cage. Acta Chir Orthop Traumatol Cech. 2006;73:157–163.
Hozack WJ. Rothman RH, Albert TJ, Balderston RA, Eng K. Relationship of total hip arthroplasty outcome to other orthopaedic procedures. Clin Orthop Relat Res. 1997;344:88–93.
Ito H, Matsuno T, Aok Y, Minami A. Total hip arthroplasty using an omniflex modular system: 5 to 12 years follow-up. Clin Orthop Relat Res. 2004; 419: 98–106.
Korovessis P, Repantis T. High Medium-term Survival of Zweymuller SLR-Plus((R)) Stem Used in Femoral Revision. Clin Orthop Relat Res. 2009;467:2032–2040.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005–2030. J Bone Joint Surg Am. 2007;89:780–785.
Lai KA, Shen WJ, Yang CY, Lin RM, Lin CJ, Jou IM. Two-stage cementless revision THR after infection. 5 recurrences in 40 cases followed 2.5 – 7 years. Acta Orthop Scand 1996; 67:325–328.
Ochs BG, Volkmann R, Eingartner C, Ludolph I, Weller S, Weise K, Ochs U. Treatment of large femoral bone defects--15-year experiences with the cementless Bicontact revision stem with distal interlocking. Z Orthop Unfall. 2007; 145(Suppl 1):S34–S39.
Ong KL, Mowat FS, Chan N, Lau E, Halpern MT, Kurtz SM. Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res. 2006;446:22–28.
Ornstein E, Linder L, Ranstam J, Lewold S, Eisler T, Torper M. Femoral Impaction bone grafting with the Exeter stem - the Swedish experience: survivorship analysis of 1305 revisions performed between 1989 and 2002. J Bone Joint Surg Br. 2009;91:441–446.
Park KS, Yoon TR, Song EK, Lee KB. Cementless Acetabular Socket Revisions Using Metasul Metal-on-Metal Bearings. J Arthroplasty. 2010;25:533–537.
Parratte S, Argenson JN, Flecher X, Aubaniac JM. Acetabular revision for aseptic loosening in total hip arthroplasty using cementless cup and impacted morselized allograft. Rev Chir Orthop Reparatrice Appar Mot. 2007; 93:255–263.
Romano CL, Romano D, Logoluso N, Meani E. Septic versus aseptic hip revision: how different? J Orthop Traumatol. 2010;11:167–174.
Schlegel UJ, Bitsch RG, Pritsch M, Aldinger PR, Mau H, Breusch SJ. Acetabular reinforcement rings in revision total hip arthroplasty: midterm results in 298 cases. Orthopade. 2008;37:904, 906–913.
Schlegel UJ, Bitsch RG, Pritsch M, Clauss M, Mau H, Breusch SJ. Mueller reinforcement rings in acetabular revision: outcome in 164 hips followed for 2–17 years. Acta Orthop. 2006;77:234–241.
Stedry V, Dungl P, Hajny P. Revision of total hip replacement operations at the Orthoedic Clinic IPVZ in Prague, 1999. Acta Chir Orthop Traumatol Cech. 2001;68:18–23.
Tamvakopoulos GS, Servant CT, Clark G, Ivory JP. Medium-term follow-up series using a modular distal fixation prosthesis to address proximal femoral bone deficiency in revision total hip arthroplasty. A 5–9 year follow-up study. Hip Int. 2007;17:143–149.
Tarasevicius S, Zegunis V, Tarasevicius R, Kalesinskas RJ, Janusonis V. Hip revision arthroplasty (long-term results). Medicina (Kaunas). 2004;40:332–337.
Tulic G, Dulic B, Vucetic C, Todorovic A. Our first experience with extended proximal femoral osteotomy for revision hip surgery. Hip Int. 2007;17:224–229.
Wang CJ, Hsieh MC, Huang TW, Wang JW, Chen HS, Liu CY. Clinical outcome and patient satisfaction in aseptic and septic revision total knee arthroplasty. Knee. 2004;11:45–49.
Weeden SH, Schmidt RH. The use of tantalum porous metal implants for Paprosky 3A and 3B defects. J Arthroplasty. 2007;22(6 Suppl 2):151–155.
Wu LD, Xiong Y, Yan SG, Yang QS, Dai XS. Femoral Component Revision using extensively porous-coated cementless stem. Chin J Traumatol. 2005; 8:358–63.
This study was partially funded by the Eduardo Salvati Resident Research Grant (MBC).
Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.
This work was performed at the Münster University Hospital.
Level of evidence: Level III therapeutic study. See levels of evidence for a complete description.
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Boettner, F., Cross, M.B., Nam, D. et al. Functional and Emotional Results Differ After Aseptic vs Septic Revision Hip Arthroplasty. HSS Jrnl 7, 235–238 (2011). https://doi.org/10.1007/s11420-011-9211-6
- hip arthroplasty