Abstract
Introduction and Aims: Functional results following revision total hip arthroplasty (THA) for infection may be inferior to those done for aseptic causes. This cross-sectional study compared the results of patients who had two-stage revision for infection using an articulating spacer device, with those of a control group who had revision for aseptic causes.
Method: Patients admitted between December 1997 and December 2000 for two-stage revision of an infected hip replacement using the PROSTALAC articulating spacer were included. They were compared to patients who had revision of both components for aseptic causes over the same time period. Patients with periprosthetic fractures were excluded.
Pre-operative function was assessed using the Charnley score and bone loss was determined from pre-operative radiographs using the Paprowsky femoral and acetabular classifications. At a minimum two years follow-up, quality of life (QOL) was assessed using the WOMAC, Oxford-12 and SF-12 questionnaires. Patient satisfaction and co-morbidity data were also collected.
Results: There were 44 septic and 105 aseptic revision arthroplasties included in the study. There were no differences between the two groups with respect to co-morbidities, Charnley group, pre-operative pain, function or range of movement or loss of acetabular bone stock. The aseptic group had significantly worse femoral bone stock than the septic group (p=0.008).
All infected patients were treated with the PROSTA-LAC system at the first stage, and 40 patients were reimplanted at the second stage procedure. In four cases, a Girdlestone procedure was performed for persistent infection, although two were re-implanted later.
Re-operations in the septic group were required in six patients for: instability (three), fractured femoral component (one), failure of ingrowth (one), and for recurrence of infection (one). Eight aseptic patients had further revisions for: instability (four), failure of component fixation (three), and for periprosthetic fracture (one).
Although the functional results for both groups were good, the results following revision for sepsis were significantly worse. The mean normalised WOMAC score for infected patients was 66.1, compared to 74.4 for aseptic patients (p=0.028) and the mean Oxford score following infection was 22.4 compared to 18.9 for controls (p=0.007). The satisfaction scores following septic revision were also significantly worse (p=0.02).
Conclusion: Use of an articulated spacer in two-stage revision was successful in eradicating infection, allowing re-implantation in more than 90% of patients, and with good recovery of function. However, the functional results and satisfaction scores were significantly worse than those of a matched control group revised for aseptic causes.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
