ONE-PHASE REVISION TOTAL HIP ARTHROPLASTY

Abstract

Purpose: We studied a consecutive multicentric series retrospectively to assess outcome after one-stage revision total hip arthroplasty without cement for infection-related failed total hip arthroplasty in patients with chronic infection (> 30 days).

Material and method: Thirty-four patients (12 women and 22 men) underwent primary arthroplasty between 1992 and 1998. Mean age was 67.8 years (range 45 – 89). Indications were primary hip degeneration (n=17), neck fracture (n=5), secondary hip degeneration (n=12). Twenty-two patients had risk factors for infection. The same treatment protocol was used for all patients: single-phase replacement of the infected implant with insertion of a hydroxyapatite coated implant without cement and a three-month antibiotic regimen adapted to intraoperative samples. Seven femorotomies were performed. Clinical, laboratory and radiological findings were used to assess outcome. Patients were considered to be cured when laboratory tests were normal and x-rays showed no signs of suspected complications.

Results: There were three failures and 31 successful revisions. Intraoperative fracture of the femur required osteosynthesis in six patients. five patients developed a drug-related complication. Isolated germs were: meticillin-sensitive staphylococcus (n=18), meticillin-resistant staphylococcus (n=6), multiple germs (n=2), other germs (n=6), undetermined (n=2). The three failures occurred in patients with meticillin-resistant staphylococcal infections.

Discussion and conclusion: Our 88% success rate is in line with data in the literature. For us, one-phase revision is the best first intention option: other techniques may be required for patients with severe infections, after failure of one-stage revision, or massive loss of bone stock. Based on the present results, we have continued to prefer this therapeutic option but long-term follow-up is needed to further support these early findings.