Abstract
Introduction
We report our mid-term results and risk factors of a two-stage revision using impaction bone grafting for an infected hip replacement.
Methods
A two-stage revision using impacted cancellous allografs and cement was performed in 13 patients (7 total hip replacements, 6 femoral head replacements) with confirmed infection. The mean age of the patients at first stage operation was 63 years (range, 45–84 years).
In the first stage, local antibiotics were added to customized cement beads and/or a cement spacer after removal of all components and radical debridement. In the second stage, impaction grafting was done using the X-change system (Exeter).
Results
Of the patients, 8 underwent multiple operations to obtain evidence that infection had been overcome in the first stage, and of them, 6 had infection due to methicillin-resistant Staphylococcus aureus (MRSA). The mean duration from first stage operation to second stage revision was 8 months (range, 3–17 months).
Only one patient suffered re-infection due to MRSA after second stage revision, which was not the original infecting agent, and the other 12 patients had satisfactory radiological outcomes. The success rate was 92% at the mean follow-up of 4 years (range, 1–10 years) after revision.
Conclusion
Allograft bone was shown to be useful for infected hip replacement with a considerable loss of bone stock. We considered that control of MRSA infection is a key factor for successful outcome.
