Abstract
Two-stage reconstruction with total implant removal and re-implantation after infection control is considered the gold standard treatment forinfection after hip arthroplasty. However, removal of the well-fixed stem or cup may cause substantial bone loss and other complications, thereby making reconstruction difficult. We evaluated whether an infection posttotal hip arthroplasty can be treated without removal of the radiographically and clinically well-fixed femoral stem or acetabular cup. Patients with a chronic infection aftertotal hip arthroplasty, with a radiographically well-fixed, cementless stem or cup, were selected. During the first surgical stage, we retained the stem or cup if we were unable to removethese with a stem or cup extractor. An antibiotic-impregnated cement spacer was then implanted. After control of infection (C-reactive proteinlevel within normal value), we performed the secondstage of re-implantation surgery. Treatment failure was defined as uncontrolled infection requiringremoval of the retained implant.
From January 2004 to December 2013, 16 patients underwent partial component-retained 2-stage reconstruction. Thirteen patients (81.3%) were free of infection, with a mean follow-up time of 5 years. The remaining 3 patients, who had high-risk comorbidities and, of whom, 2 were infected by high-virulence organism, had uncontrolled infection and required furthersurgery to remove the retained implant.
We conclude that partial component-retained 2-stage reconstruction could be an alternative treatment option for chronic infection afteran uncemented total hip arthroplasty with a radiographically and clinically well-fixed component in selected patients, who are notimmunocompromised and are infected by a low-virulence organism.
