PERIPROSTHETIC HIP INFECTION MANAGEMENT: AN ALTERNATIVE TO DECREASE MORBIDITY

Abstract

Staged revision arthroplasty for the periprosthetic hip infection is the accepted mode of treatment. Unfortunately, the first stage revision compromises the patient’s function secondary to inability to weight-bear. Pros-theses coated with antibiotic-loaded cement have been adapted to improve function but have failed in larger femoral defects. This implant and technique described improves patient mobility and decreases morbidity as compared to conventional techniques.

The purpose of this study was to find an implant to accommodate most femoral defects and to be readily available for managing periprosthetic hip infections

A prospective study was performed comparing the PROSTALAC(DePuy, IN) implant (Group I) to a Solution(DePuy, IN) implant (Group II) covered in antibiotics for management of the first stage. All patients had a confirmed pyogenic gram positive or gram negative infection. Fifty-two patients were compared with each group being matched by their femoral defect type (Paprosky: Type I and II: 24, Type III:20, Type IV: 8). Follow-up was for a minimum of thirty-six months. All patients were encouraged to weight bear as tolerated.

One recurrence of infection occurred after a second stage revision in Group I. Cost of the implant averaged $700 cheaper in Group II. More significant was the fact that the average length of hospital stay was decreased in Group II by seven days and forty-seven days for the Type III and Type IV femurs respectively. All patients in Group I received a second stage revision. Five of the Group II patients refused a second stage revision secondary to their satisfactory function and had better post-op function.

An alternative treatment for staged periprosthetic hip infections is proposed which can decrease hospital stay, improve function, and allow routine implant use for its implementation.