TWO-STAGE HIP REPLACEMENT USING NON-CEMENTED IMPLANTS IN PATIENTS WITH INFECTED TOTAL HIP ARTHROPLASTY

Abstract

Introduction: From 1972–2003, 205 arthroplasties of infected hips were performed in the Musculoskeletal Infectious Disease Unit of our hospital. Using as a basis the outcome for conventional one-and two-stage hip replacement with cemented implants and antibiotics performed in these patients, we designed a new two-stage hip replacement protocol using «personalized» solid spacers and non-cemented components.

Material and Methods: A total of 44 patients were treated with our protocol. Patient characteristics are described, as well as an elevated incidence of associated disease, the causative microorganisms, and therapy provided. Most of the cases had failed other treatment methods. Strict application of the protocol implied:

1. Previous identification of the infective microorganism

2. First-stage surgery including radical debridement and placement of «personalized» spacers.

3. Specific antibiotic treatment during three months.

4. Second-stage surgery including second debridement, withdrawal of the spacers, collection of samples for microbiologic and histologic study (including intraoperative PMN study). Implantation of prosthesis without use of cement.

Results: Reactivation of infection occurred in only one case. The patient was cured with antibiotic administration. The remaining patients remained free of infection for a mean follow up period of 64.54 months (19.77–86.63 months). The septic process was erradicated in 96% of cases. Five-year implant survival was 100%.

Conclusions:

1. Cement with antibiotics is not essential for prosthesis reimplantation when replacement is performed in two-stage.

2. Outcome in patients treated according to this protocol is equal or superior to that of other technique options (eradication of the septic process for a mean of more than 5 years).

3. Prosthesis survival results justify the exclusion of cement for reimplantation.