Skip to main content

Advertisement

SpringerLink
Log in

Partial Two-stage Exchange for Infected Total Hip Arthroplasty: A Preliminary Report

  • Symposium: 2013 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

One common approach to the infected total hip arthroplasty (THA) calls for a staged revision, including removal of all components. However, removal of well-fixed femoral components can result in bone loss and compromised fixation; it is not known whether it is effective to leave a well-fixed femoral component in situ, remove only the acetabular component, débride thoroughly, place a spacer, and delay reimplantation.

Questions/purposes

The purposes of this study were to determine (1) the frequency of infection recurrence; (2) the frequency of death; and (3) the Harris hip scores of patients treated with a “two-stage partial exchange” approach.

Methods

A retrospective analysis from 2000 through January 2011 revealed 19 patients with infected THA treated with partial two-stage exchange including complete acetabular component removal, aggressive soft tissue débridement, retention of the well-fixed femoral stem, placement of an antibiotic-laden cement femoral head on the trunnion of the retained stem, postoperative course of antibiotics, and delayed reimplantation. Indications for this treatment included those patients whose femoral component was determined to be well fixed and its removal would result in significant femoral bone loss and compromise of future fixation. During the study period, this represented 7% (19 of 262) of the patients whom we treated for a chronically infected THA. Minimum followup was 2 years (mean, 4 years; range, 2–11 years). None of the 19 patients in this series were lost to followup. We defined failure as recurrence of infection in the same hip or the use of long-term suppressive antibiotics.

Results

Two patients (11%), both with prior failure of two-staged treatment of infection, failed secondary to recurrence of infection at an average of 3.3 years. There were no patient deaths within 90 days. The mean Harris hip score was 68 (range, 31–100; best score is 100).

Conclusions

Insofar as 89% of patients in this series were clinically free of infection at a minimum of 2 years, we believe partial two-stage exchange may represent an acceptable option for patients with infected THA when femoral component removal would result in significant bone loss and compromise of reconstruction. Further study is required on this approach.

Level of Evidence

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–B
Fig. 2A–B
Fig. 3A–B
Fig. 4

Similar content being viewed by others

References

  1. Berend KR, Lombardi AV Jr, Morris MJ, Bergeson AG, Adams JB, Sneller MA. Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res. 2013;471:510–518.

    Article  PubMed  Google Scholar 

  2. Berry DJ, Chandler HP, Reilly DT. The use of bone allografts in two-stage reconstruction after failure of hip replacements due to infection. J Bone Joint Surg Am. 1991;73:1460–1468.

    CAS  PubMed  Google Scholar 

  3. Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am. 2005;87:1746–1751.

    Article  PubMed  Google Scholar 

  4. Buttaro MA, Pusso R, Piccaluga F. Vancomycin-supplemented impacted bone allografts in infected hip arthroplasty. Two-stage revision results. J Bone Joint Surg Br. 2005;87:314–319.

    Article  CAS  PubMed  Google Scholar 

  5. Cabrita HB, Croci AT, Camargo OP, Lima AL. Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer. Clinics (Sao Paulo). 2007;62:99–108.

    Article  PubMed  Google Scholar 

  6. Callaghan JJ, Katz RP, Johnston RC. One-stage revision surgery of the infected hip. A minimum 10-year followup study. Clin Orthop Relat Res. 1999;369:139–143.

    Article  PubMed  Google Scholar 

  7. Cordero-Ampuero J, Esteban J, García-Cimbrelo E. Oral antibiotics are effective for highly resistant hip arthroplasty infections. Clin Orthop Relat Res. 2009;467:2335–2342.

    Article  PubMed  Google Scholar 

  8. Dairaku K, Takagi M, Kawaji H, Sasaki K, Ishii M, Ogino T. Antibiotics-impregnated cement spacers in the first step of two-stage revision for infected totally replaced hip joints: report of ten trial cases. J Orthop Sci. 2009;14:704–710.

    Article  PubMed  Google Scholar 

  9. Darley ES, Bannister GC, Blom AW, Macgowan AP, Jacobson SK, Alfouzan W. Role of early intravenous to oral antibiotic switch therapy in the management of prosthetic hip infection treated with one- or two-stage replacement. J Antimicrob Chemother. 2011;66:2405–2408.

    Article  CAS  PubMed  Google Scholar 

  10. Della Valle CJ, Paprosky WG. Classification and an algorithmic approach to the reconstruction of femoral deficiency in revision total hip arthroplasty. J Bone Joint Surg Am. 2003;85(Suppl 4):1–6.

    Google Scholar 

  11. Drancourt M, Stein A, Argenson JN, Zannier A, Curvale G, Raoult D. Oral rifampin plus ofloxacin for treatment of Staphylococcus-infected orthopedic implants. Antimicrob Agents Chemother. 1993;37:1214–1218.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Engesæter LB, Dale H, Schrama JC, Hallan G, Lie SA. Surgical procedures in the treatment of 784 infected THAs reported to the Norwegian Arthroplasty Register. Acta Orthop. 2011;82:530–537.

    Article  PubMed  Google Scholar 

  13. Erhart J, Jaklitsch K, Schurz M, Vécsei V, Ehall R. Cementless two-staged total hip arthroplasty with a short term interval period for chronic deep periprosthetic infection. Technique and long-term results. Wien Klin Wochenschr. 2010;122:303–310.

    Article  PubMed  Google Scholar 

  14. Evans RP. Successful treatment of total hip and knee infection with articulating antibiotic components: a modified treatment method. Clin Orthop Relat Res. 2004;427:37–46.

    Article  PubMed  Google Scholar 

  15. Fehring TK, Calton TF, Griffin WL. Cementless fixation in 2-stage reimplantation for periprosthetic sepsis. J Arthroplasty. 1999;14:175–181.

    Article  CAS  PubMed  Google Scholar 

  16. Fink B, Rechtenbach A, Büchner H, Vogt S, Hahn M. Articulating spacers used in two-stage revision of infected hip and knee prostheses abrade with time. Clin Orthop Relat Res. 2011;469:1095–1102.

    Article  PubMed  Google Scholar 

  17. Gao H, Lv H. [One-stage revision operations for infection after hip arthroplasty] [in Chinese]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008;22:5–8.

    CAS  PubMed  Google Scholar 

  18. García S, Soriano A, Esteban P, Almela M, Gallart X, Mensa J. [Usefulness of adding antibiotic to cement in one stage exchange of chronic infection in total hip arthroplasty] [in Spanish]. Med Clin (Barc). 2005;125:138–139.

    Article  PubMed  Google Scholar 

  19. Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect. 1999;48:111–122.

    CAS  PubMed  Google Scholar 

  20. Hanssen AD, Spangehl MJ. Treatment of the infected hip replacement. Clin Orthop Relat Res. 2004;420:63–71.

    Article  PubMed  Google Scholar 

  21. Harris WH. 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. 1969;51:737–755.

    CAS  PubMed  Google Scholar 

  22. Hofmann AA, Goldberg TD, Tanner AM, Cook TM. Ten-year experience using an articulating antibiotic cement hip spacer for the treatment of chronically infected total hip. J Arthroplasty. 2005;20:874–879.

    Article  PubMed  Google Scholar 

  23. Hsieh PH, Huang KC, Lee PC, Lee MS. Two-stage revision of infected hip arthroplasty using an antibiotic-loaded spacer: retrospective comparison between short-term and prolonged antibiotic therapy. J Antimicrob Chemother. 2009;64:392–397.

    Article  CAS  PubMed  Google Scholar 

  24. Hsieh PH, Shih CH, Chang YH, Lee MS, Shih HN, Yang WE. Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am. 2004;86:1989–1997.

    PubMed  Google Scholar 

  25. Hsieh PH, Shih CH, Chang YH, Lee MS, Yang WE, Shih HN. Treatment of deep infection of the hip associated with massive bone loss: two-stage revision with an antibiotic-loaded interim cement prosthesis followed by reconstruction with allograft. J Bone Joint Surg Br. 2005;87:770–775.

    Article  PubMed  Google Scholar 

  26. Huang R, Hu CC, Adeli B, Mortazavi J, Parvizi J. Culture-negative periprosthetic joint infection does not preclude infection control. Clin Orthop Relat Res. 2012;470:2717–2723.

    Article  PubMed  Google Scholar 

  27. Incavo SJ, Russell RD, Mathis KB, Adams H. Initial results of managing severe bone loss in infected total joint arthroplasty using customized articulating spacers. J Arthroplasty. 2009;24:607–613.

    Article  PubMed  Google Scholar 

  28. Isiklar ZU, Demirörs H, Akpinar S, Tandogan RN, Alparslan M. Two-stage treatment of chronic staphylococcal orthopaedic implant-related infections using vancomycin impregnated PMMA spacer and rifampin containing antibiotic protocol. Bull Hosp Jt Dis. 1999;58:79–85.

    CAS  PubMed  Google Scholar 

  29. Jackson WO, Schmalzried TP. Limited role of direct exchange arthroplasty in the treatment of infected total hip replacements. Clin Orthop Relat Res. 2000;381:101–105.

    Article  PubMed  Google Scholar 

  30. Jahoda D, Sosna A, Landor I, Vavrík P, Pokorný D, Hudec T. [Two-stage reimplantation using spacers—the method of choice in treatment of hip joint prosthesis-related infections. Comparison with methods used from 1979 to 1998] [in Czech]. Acta Chir Orthop Traumatol Cech. 2003;70:17–24.

    CAS  PubMed  Google Scholar 

  31. Karpas K, Sponer P. Management of the infected hip arthroplasty by two-stage reimplantation. Acta Medica (Hradec Kralove). 2003;46:113–115.

    Google Scholar 

  32. Klouche S, Leonard P, Zeller V, Lhotellier L, Graff W, Leclerc P, Mamoudy P, Sariali E. Infected total hip arthroplasty revision: one- or two-stage procedure? Orthop Traumatol Surg Res. 2012;98:144–150.

    Article  CAS  PubMed  Google Scholar 

  33. Koo KH, Yang JW, Cho SH, Song HR, Park HB, Ha YC, Chang JD, Kim SY, Kim YH. Impregnation of vancomycin, gentamicin, and cefotaxime in a cement spacer for two-stage cementless reconstruction in infected total hip arthroplasty. J Arthroplasty. 2001;16:882–892.

    Article  CAS  PubMed  Google Scholar 

  34. Kraay MJ, Goldberg VM, Fitzgerald SJ, Salata MJ. Cementless two-staged total hip arthroplasty for deep periprosthetic infection. Clin Orthop Relat Res. 2005;441:243–249.

    Article  PubMed  Google Scholar 

  35. 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.

    Article  CAS  PubMed  Google Scholar 

  36. Lee PT, Clayton RA, Safir OA, Backstein DJ, Gross AE. Structural allograft as an option for treating infected hip arthroplasty with massive bone loss. Clin Orthop Relat Res. 2011;469:1016–1023.

    Article  PubMed  Google Scholar 

  37. Lee YK, Lee KH, Nho JH, Ha YC, Koo KH. Retaining well-fixed cementless stem in the treatment of infected hip arthroplasty. Good results in 19 patients followed for mean 4 years. Acta Orthop. 2013;84:260–264.

    Article  PubMed  Google Scholar 

  38. Leone JM, Hanssen AD. Management of infection at the site of a total knee arthroplasty. J Bone Joint Surg Am. 2005;87:2335–2348.

    PubMed  Google Scholar 

  39. Leung F, Richards CJ, Garbuz DS, Masri BA, Duncan CP. Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection? Clin Orthop Relat Res. 2011;469:1009–1015.

    Article  PubMed  Google Scholar 

  40. Lieberman JR, Callaway GH, Salvati EA, Pellicci PM, Brause BD. Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol. Clin Orthop Relat Res. 1994;301:205–212.

    PubMed  Google Scholar 

  41. Lim SJ, Park JC, Moon YW, Park YS. Treatment of periprosthetic hip infection caused by resistant microorganisms using 2-stage reimplantation protocol. J Arthroplasty. 2009;28:1264–1269.

    Article  Google Scholar 

  42. Lombardi AV Jr, Berend KR. The shattered femur: radical solution options. J Arthroplasty. 2006;21(Suppl 1):107–111.

    Article  PubMed  Google Scholar 

  43. Magnan B, Regis D, Biscaglia R, Bartolozzi P. Preformed acrylic bone cement spacer loaded with antibiotics: use of two-stage procedure in 10 patients because of infected hips after total replacement. Acta Orthop Scand. 2001;72:591–594.

    Article  CAS  PubMed  Google Scholar 

  44. Maurer SG, Baitner AC, Di Cesare PE. Reconstruction of the failed femoral component and proximal femoral bone loss in revision hip surgery. J Am Acad Orthop Surg. 2000;8:354–363.

    CAS  PubMed  Google Scholar 

  45. McDonald DJ, Fitzgerald RH Jr, Ilstrup DM. Two-stage reconstruction of a total hip arthroplasty because of infection. J Bone Joint Surg Am. 1989;71:828–834.

    CAS  PubMed  Google Scholar 

  46. Morley JR, Blake SM, Hubble MJ, Timperley AJ, Gie GA, Howell JR. Preservation of the original femoral cement mantle during the management of infected cemented total hip replacement by two-stage revision. J Bone Joint Surg Br. 2012;94:322–327.

    Article  CAS  PubMed  Google Scholar 

  47. Mulcahy DM, O’Byrne JM, Fenelon GE. One stage surgical management of deep infection of total hip arthroplasty. Ir J Med Sci. 1996;165:17–19.

    Article  CAS  PubMed  Google Scholar 

  48. Nestor BJ, Hanssen AD, Ferrer-Gonzalez R, Fitzgerald RH Jr. The use of porous prostheses in delayed reconstruction of total hip replacements that have failed because of infection. J Bone Joint Surg Am. 1994;76:349–359.

    CAS  PubMed  Google Scholar 

  49. Neumann DR, Hofstaedter T, List C, Dorn U. Two-stage cementless revision of late total hip arthroplasty infection using a premanufactured spacer. J Arthroplasty. 2012;27:1397–1401.

    Article  PubMed  Google Scholar 

  50. Nusem I, Morgan DA. Structural allografts for bone stock reconstruction in two-stage revision for infected total hip arthroplasty: good outcome in 16 of 18 patients followed for 5–14 years. Acta Orthop. 2006;77:92–97.

    Article  PubMed  Google Scholar 

  51. Oussedik SI, Dodd MB, Haddad FS. Outcomes of revision total hip replacement for infection after grading according to a standard protocol. J Bone Joint Surg Br. 2010;92:1222–1226.

    Article  CAS  PubMed  Google Scholar 

  52. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;469:2992–2994.

    Article  PubMed  Google Scholar 

  53. Raut VV, Orth MS, Orth MC, Siney PD, Wroblewski BM. One stage revision arthroplasty of the hip for deep Gram negative infection. Int Orthop. 1996;20:12–14.

    Article  CAS  PubMed  Google Scholar 

  54. Raut VV, Siney PD, Wroblewski BM. One-stage revision of infected total hip replacements with discharging sinuses. J Bone Joint Surg Br. 1994;76:721–724.

    CAS  PubMed  Google Scholar 

  55. Raut VV, Siney PD, Wroblewski BM. One-stage revision of total hip arthroplasty for deep infection. Long-term followup. Clin Orthop Relat Res. 1995;321:202–207.

    PubMed  Google Scholar 

  56. Romanò CL, Romanò D, Albisetti A, Meani E. Preformed antibiotic-loaded cement spacers for two-stage revision of infected total hip arthroplasty. Long-term results. Hip Int. 2012;22(Suppl 8):S46–53.

    Article  PubMed  Google Scholar 

  57. Romanò CL, Romanò D, Logoluso N, Meani E. Long-stem versus short-stem preformed antibiotic-loaded cement spacers for two-stage revision of infected total hip arthroplasty. Hip Int. 2010;20:26–33.

    PubMed  Google Scholar 

  58. Rudelli S, Uip D, Honda E, Lima AL. One-stage revision of infected total hip arthroplasty with bone graft. J Arthroplasty. 2008;23:1165–1177.

    Article  PubMed  Google Scholar 

  59. Salvati EA, González Della Valle A, Masri BA, Duncan CP. The infected total hip arthroplasty. Instr Course Lect. 2003;52:223–245.

    PubMed  Google Scholar 

  60. Sanchez-Sotelo J, Berry DJ, Hanssen AD, Cabanela ME. Midterm to long-term followup of staged reimplantation for infected hip arthroplasty. Clin Orthop Relat Res. 2009;467:219–224.

    Article  PubMed  Google Scholar 

  61. Scharfenberger A, Clark M, Lavoie G, O’Connor G, Masson E, Beaupre LA. Treatment of an infected total hip replacement with the PROSTALAC system. Part 1: Infection resolution. Can J Surg. 2007;50:24–28.

    PubMed Central  PubMed  Google Scholar 

  62. Spangehl MJ, Younger AS, Masri BA, Duncan CP. Diagnosis of infection following total hip arthroplasty. Instr Course Lect. 1998;47:285–295.

    CAS  PubMed  Google Scholar 

  63. Stockley I, Mockford BJ, Hoad-Reddick A, Norman P. The use of two-stage exchange arthroplasty with depot antibiotics in the absence of long-term antibiotic therapy in infected total hip replacement. J Bone Joint Surg Br. 2008;90:145–148.

    Article  CAS  PubMed  Google Scholar 

  64. Takigami I, Ito Y, Ishimaru D, Ogawa H, Mori N, Shimizu T, Terabayashi N, Shimizu K. Two-stage revision surgery for hip prosthesis infection using antibiotic-loaded porous hydroxyapatite blocks. Arch Orthop Trauma Surg. 2010;130:1221–1226.

    Article  PubMed  Google Scholar 

  65. Toulson C, Walcott-Sapp S, Hur J, Salvati E, Bostrom M, Brause B, Westrich GH. Treatment of infected total hip arthroplasty with a 2-stage reimplantation protocol: update on ‘our institution’s’ experience from 1989 to 2003. J Arthroplasty. 2009;24:1051–1060.

    Article  PubMed  Google Scholar 

  66. Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am. 1996;78:512–523.

    CAS  PubMed  Google Scholar 

  67. Walter G, Bühler M, Hoffmann R. [Two-stage procedure to exchange septic total hip arthroplasties with late periprosthetic infection. Early results after implantation of a reverse modular hybrid endoprosthesis] [in German]. Unfallchirurg. 2007;110:537–546.

    Article  CAS  PubMed  Google Scholar 

  68. Wang JW, Chen CE. Reimplantation of infected hip arthroplasties using bone allografts. Clin Orthop Relat Res. 1997;335:202–210.

    Article  PubMed  Google Scholar 

  69. Whittaker JP, Warren RE, Jones RS, Gregson PA. Is prolonged systemic antibiotic treatment essential in two-stage revision hip replacement for chronic Gram-positive infection? J Bone Joint Surg Br. 2009;91:44–51.

    Article  CAS  PubMed  Google Scholar 

  70. Winkler H, Stoiber A, Kaudela K, Winter F, Menschik F. One stage uncemented revision of infected total hip replacement using cancellous allograft bone impregnated with antibiotics. J Bone Joint Surg Br. 2008;90:1580–1584.

    Article  CAS  PubMed  Google Scholar 

  71. Yamamoto K, Miyagawa N, Masaoka T, Katori Y, Shishido T, Imakiire A. Clinical effectiveness of antibiotic-impregnated cement spacers for the treatment of infected implants of the hip joint. J Orthop Sci. 2003;8:823–828.

    Article  PubMed  Google Scholar 

  72. Yoo JJ, Kwon YS, Koo KH, Yoon KS, Kim YM, Kim HJ. One-stage cementless revision arthroplasty for infected hip replacements. Int Orthop. 2009;33:1195–1201.

    Article  PubMed Central  PubMed  Google Scholar 

  73. Younger AS, Duncan CP, Masri BA. Treatment of infection associated with segmental bone loss in the proximal part of the femur in two stages with use of an antibiotic-loaded interval prosthesis. J Bone Joint Surg Am. 1998;80:60–69.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Joint Implant Surgeons, Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH, 43054, USA

    Timothy E. Ekpo DO, Keith R. Berend MD, Michael J. Morris MD, Joanne B. Adams BFA & Adolph V. Lombardi Jr MD

  2. The Ohio State University, Columbus, OH, USA

    Keith R. Berend MD & Adolph V. Lombardi Jr MD

  3. Mount Carmel Health System, New Albany, OH, USA

    Keith R. Berend MD, Michael J. Morris MD & Adolph V. Lombardi Jr MD

Authors
  1. Timothy E. Ekpo DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keith R. Berend MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael J. Morris MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joanne B. Adams BFA
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adolph V. Lombardi Jr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adolph V. Lombardi Jr MD.

Additional information

The institution (Joint Implant Surgeons, Inc, New Albany, OH, USA) of one or more of the authors has received funding from Biomet Inc (Warsaw, IN, USA) and Stryker Orthopaedics (Mahwah, NJ, USA) (TEE, KRB, MJM, JBA, AVL). One of the authors certifies that he (AVL) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet Inc, and an amount of USD 10,000 to USD 100,000 from Innomed, Inc (Savannah, GA, USA). One of the authors certifies that he (KRB) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet Inc. One of the authors certifies that he (MJM) has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Biomet Inc.

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.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution has 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 Joint Implant Surgeons, Inc, New Albany, OH, USA.

About this article

Cite this article

Ekpo, T.E., Berend, K.R., Morris, M.J. et al. Partial Two-stage Exchange for Infected Total Hip Arthroplasty: A Preliminary Report. Clin Orthop Relat Res 472, 437–448 (2014). https://doi.org/10.1007/s11999-013-3168-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-013-3168-3

Keywords

Search

Navigation