S08.6 THE MANAGEMENT OF SEPTIC TOTAL HIP REPLACEMENT: AN ALTERNATIVE PROCEDURE WITH PARTIAL HIP SPACERS

Abstract

Introduction: Infection is probably the most frightful complication associated with Total Hip Replacement

This infrequent complication occurs with a frequency ranging from 0,6% to 1,1% depending series, and in Revision cases it may rise up 20%.

We expose our experience in the treatment of infection associated with THR using the two-stage procedure with hand-made partial hip spacers.

Patients and Methods: Between August 1998 and March 2009, 9 patients underwent a two-stage revision procedure for infected Hip Replacement using partial hip spacers.

There were 5 men and 4 women, with an average age of 65 years, ranging from 35 to 76. 3 patients had previous surgery before presenting to our hospital.

The infecting pathogen was Gram positive in 6 out of 9 patients (66,7%), Gram negative in 2 patients (22,2%) and in the remaining patients the pathogen was not detected.

No clinical signs nor radiological findings suggested septic loosening of the femoral component, except in one patient.

The partial spacer consisted on a ball of acrylic cement with antibiotics (usually an aminoglycoside i.e. gentamicin) which is manipulated by the surgeon in order to be placed in the acetabulum. In 8 out of 9 patients femoral component was not removed.

All the patients received systemic antibiotic treatment with two or more antibiotics for more than 6 weeks after the first stage, on the basis of the antibiogram.

Results: Hip function was recorded using the method of Merle d’Aubigne, which it consists on a scoring system including pain, walking ability and range of movement. 7 patients (77,8%) had excellent or good results.

The average between the first and second-stage operations ranged from 8 to 24 weeks (mean 15,7 +− 2.1). During this period of time most patients had tolerable pain in the hip.

Success rates in terms of recurrence of infection after Revision surgery was 11,1%.

One patient presented a fistulae one year after second time surgery, and fistulectomy was carried out.

Discussion: In our experience a two-stage revision procedure with temporary implantation of a partial hip spacer allowed us to achieve a high rate of successful results in the treatment of infected Hip Arthroplasty.

The use of a hand-made device offers some advantages with respect conventional hip spacers. Easier implantation, preservation medullary canal and preservation of bone stock not requiring an extended throcanteric osteotomy for the removal of an infected long stem, especially in older patients with important associated morbidity.