OUTCOMES AFTER STAGING OF REVISION HIP ARTHROPLASTY FOR INFECTION ACCORDING TO STANDARD PROTOCOL

Abstract

The management of infected total hip replacements remains controversial. The standard of care is two stage revision with antibiotic load ed cement during the interval period and parental antibiotic therapy for six weeks. Single stage revision may have economic and functional advantages however.

Fifty consecutive patients with infected total hip replacements were treated according to a Standard Protocol. Patients were selected for single or two stage revision based on their general characteristics, the infecting organisms and type of reconstruction to be used. If a single sensitive organism was identified and antibiotics were available to use antibiotic loaded cement on the femoral side then a single stage revision was undertaken.

Eleven patients underwent a single stage revision and 39 two stage revision. All 11 patients who underwent single stage revision had femoral components inserted using antibiotic loaded cement. Six had uncemented acetabular components. All the patients were reviewed at a minimum of 2 years post surgery. There was evidence of re-infection in two cases who were treated w ith two stage exchange and in none of the one stage revisions. The average Harris hip score in the patients treated with one stage exchange improved from 42 to 85. In the patients treated with two stages the scores improved from 36 to 73. Patients with one stage exchange were significantly more satisfied than those undergoing two stage exchange.

Single stage exchange arthroplasty can be performed in selected patients with excellent success rates. We have not seen any detrimental effects of using uncemented acetabular components in these cases although we continue to use cement on the femoral side to provide a high local antibiotic load. At a minimum of 2 years of follow up of single stage revision appears to offer some advantages in specific patients over two stage exchange.