Abstract
Introduction
To evaluate the clinical success and hip pain and function of patients with infected hip replacement treated by two-stage exchange using a temporary implant with high dose vancomycin added to the antibiotic cement at the first stage revision.
Method
Thirty-three hips in 32 patients (median 67 yrs) underwent first stage revision using the PROSTALAC™ system (n=27) or a self-made system using an Elite long stem (n=6). Infection was diagnosed after 19 primary, 11 revision and 3 hemiarthroplasty hip replacements. Patients were reviewed regularly clinically and by questionnaire. The median follow-up was 3 years.
Results
Five hips (15%) had repeat first stage for persistent infection. Twenty-four hips (73%) progressed to second stage. Five hips (15%) did not progress to second stage. Four hips (12%) underwent excision arthroplasty. There was a further one recurrence of infection (4%) requiring repeat two stage revision at 3 years. Patients reported, on average, minimal to no hip pain after second stage. The median Harris Hip Score (HHS) after first stage was 59, and at 2 years after second stage was 75. For comparison, the 2 year HHS in our patients that had undergone standard cemented femoral revision was 75.
Conclusion
A temporary hip implant with high-dose vancomycin cement has improved our clinical management of infected hip replacement after the second stage THR. Patients report hip pain and function that compares to that achieved for standard revision hip replacement
