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Outcome of One-stage Cementless Exchange for Acute Postoperative Periprosthetic Hip Infection

  • Symposium: 2012 Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights® to this article was published on 19 July 2013

Abstract

Background

Acute postoperative infection after total hip arthroplasty (THA) is typically treated with irrigation and débridement and exchange of the modular femoral head and acetabular liner. Given a rate of failure exceeding 50% in some series, a one-stage exchange has been suggested as a potential alternative because it allows more thorough débridement and removal of colonized implants. To date, most studies published on the one-stage exchange have used microbe-specific antibiotic-laden bone cement with only one small single-institution series that reported outcomes after a cementless one-stage exchange.

Questions/purposes

We determined whether a one-stage cementless exchange for treating acute postoperative infection after THA would result in infection control with component retention and normalization of infection markers.

Methods

We retrospectively identified 27 patients who underwent a one-stage exchange performed for an acute (≤ 6 weeks) postoperative infection after THA from April 2004 to December 2009. Primary cementless components were used both at the time of the index arthroplasty and the revision in all patients. Surgery was followed by a 6-week course of culture-specific antibiotics in all patients and a variable course of oral antibiotics. Our primary outcome was retention of the implants at most recent followup and our secondary outcome was normalization of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) at most recent followup. Patients were followed until failure or a minimum of 2 years.

Results

At a minimum followup of 27 months (mean, 50 months; range, 27–89 months), 19 of the 27 patients (70%) retained their implants but four required further operative débridement with component retention at a mean of 3 weeks (range, 2–6 weeks) to obtain control of infection. Thus, an isolated single-stage exchange was successful in 15 of the 27 patients (56%). Eight patients (30%) ultimately had a two-stage exchange for persistent infection; seven of these patients required no further surgery, whereas one patient required a second two-stage exchange. Of those patients retaining their prosthesis after one-stage exchange and tracked with ESR and CRP, four (33% [four of 12]) had elevated values without other signs or symptoms of recurrent infection.

Conclusions

For acute postoperative infection after primary THA, a one-stage cementless exchange allowed 70% of patients to retain their implants at most recent followup. Of those patients who ultimately went on to a two-stage exchange, only one required a second two-stage exchange.

Level of Evidence

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

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Acknowledgments

We thank Richard Berger MD, for contributing cases to this clinical series.

Author information

Authors and Affiliations

  1. Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA, 19107, USA

    Erik Hansen MD, Benjamin Zmistowski BS, Javad Parvizi MD & William J. Hozack MD

  2. Rush University Medical Center, Chicago, IL, USA

    Matthew Tetreault BS & Craig J. Della Valle MD

  3. University College Hospital, London, UK

    Fares S. Haddad MD

Authors
  1. Erik Hansen MD
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  2. Matthew Tetreault BS
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  3. Benjamin Zmistowski BS
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  4. Craig J. Della Valle MD
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  5. Javad Parvizi MD
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  6. Fares S. Haddad MD
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  7. William J. Hozack MD
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Corresponding author

Correspondence to Javad Parvizi MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Rothman Institute, Philadelphia, PA, USA; the Rush University Medical Center, Chicago, IL, USA; and University College Hospital, London, UK.

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Hansen, E., Tetreault, M., Zmistowski, B. et al. Outcome of One-stage Cementless Exchange for Acute Postoperative Periprosthetic Hip Infection. Clin Orthop Relat Res 471, 3214–3222 (2013). https://doi.org/10.1007/s11999-013-3079-3

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  • DOI: https://doi.org/10.1007/s11999-013-3079-3

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