Abstract
The increasing infection burden after hip arthroplasty has seen a growth of two-stage exchange and the use of increasingly powerful antibiotics at the time of this procedure. We have seen an increased number of failed two-stage revisions over the past decade. This study was aimed at clarifying the outcome of failed two-stage exchange arthroplasty after periprosthetic hip infection.
We identified forty-two patients who had undergone at least one prior two-stage revision hip arthroplasty for periprosthetic infection between 2000 and 2012. These patients were referred to our center and treated with a further two-stage exchange. They have been analyzed with a minimum two-year follow-up.
Control of infection at two-year follow-up was seen in 57% of patients. In 43% of patients there are still ongoing issues that either required further surgery or ongoing antibiotic suppression.
A regression analysis was undertaken which suggested that the immunocompromised host and polymicrobial infection were the greatest predictors of failure. The number of previous interventions, the organism involved and the duration of antibiotic therapy after the initial two-stage revision were not linked to the ultimate outcome.
The failure rate of repeat revision two-stage exchange is high and novel methods of treatment including host optimization, immunomodulation, longer interval periods, novel antimicrobial methods and more powerful antibiotic therapies should be investigated.
