Partial single-stage revision for chronic infected total hip arthroplasty / 中华骨科杂志

ABSTRACT

Objective@#To evaluate the mid-term outcomes of patients with chronic infected total hip arthroplasty (THA) after partial single-stage revision.@*Methods@#From July 2000 to October 2013, a total of 31 patients (18 males and 13 females, mean age 54 years, mean BMI 24.7 kg/m2) with chronic infected THA underwent partial single-stage revision in our hospital were retrospectively analyzed in the present study. According to the fixation type and the material of the prosthesis, selective revision of the acetabular cup or femoral stem was performed by preoperative imaging and intraoperative evaluation. The characteristics of procedure included changing femoral head and liner components, aggressive soft tissue debridement, retention of the well-fixed femoral stem or acetabular cup, thorough exposed component brushing, adequate surgical area soaking by iodine and vancomycin powder used in medullary space. Pre- and post-operative outcomes were evaluated with the Harris hip score. The frequency of infection recurrence was recorded and the failure treatment of infection was defined as recurrence of infection in the same hip.@*Results@#Acetabular cups were revised in 22 patients and femoral stems in nine patients. The average follow-up was 7.2±2.6 years (4.8-15.1 years). There were 4 (13%) failures during the study period at an average of 15 months (9-21 months) after partial single-stage revision. Two cases of them had grade A incision healing and another two cases had grade B incision healing. Of the 31 patients, a total of 27 (87%) patients had satisfactory outcomes with grade A incision healing and required no additional surgical or medical treatment for recurrence of infection. The Harris hip score was improved from 45.2±5.4 pre-operatively to 70.1±4.3 at one year post-operatively. The Harris hip score at 2 years and 5 years after surgery were 75.3±5.1 and 73.2±5.3, respectively.@*Conclusion@#In treating chronic infected THA, partial single-stage revision can be conducted fairly effective in eradication of infection and achieving acceptable functional outcomes while reducing surgical injury, which indicated that this is an attractive alternation in selected patients.