Abstract
Introduction
It is still controversial whether one or two-stage revision should be indicated for deeply infected hip prosthesis, and there are no scoring systems for the decision of them. An assessment system for the treatment of deeply infected hip prosthesis was evaluated for the patients who had undergone one or two-stage revision total hip arthroplasty (THA).
Materials and Methods
Between February 2001 and November 2009, revision THA for deep infection was carried out in 60 hips on 59 patients by the senior authors. Nineteen hips underwent one-stage revision THA using antibiotic-loaded acrylic cement (ALAC), and 41 hips did two-stage revision THA using ALAC beads, based on the criteria by Jackson and Schmalzried. This study included 47 revisions in 47 patients for which a minimum follow-up of two years (average 4.7 years). Six parameters were employed in the assessment system: 1) general condition, 2) duration of infection, 3) wound complication after initial operation, 4) microorganism, 5) C-reactive protein (CRP), and 6) necessity for grafting bone. Each parameter ranged from 0 to 2 points, giving a full score of 12 points. Healing was defined as the lack of clinical signs and symptoms of infection, a CRP level < 10 mg/l or an erythrocyte sedimentation rate < 20 mm/h, and the absence or radiological signs of infection at the follow-up visit > 24 months after first revision, described by Giulieri et al.
Results
Forty-five hips (95.7%) were free of infection at the time of the latest follow-up. Healing rates in one and two-stage revision THA were 93.3% (14/15) and 96.9% (31/32). Of the 15 patients in one-stage revision THA, the average total score in success and failed cases were 9.7 ± 0.7 points (range, 9 to 11 points) and 6 points, respectively. Of the 32 patients in two-stage revision THA, the average total score in success, recurred and failed cases were 8.3 ± 1.6 points (6 to 11 points), 9.5 ± 0.6 points (9 to 10 points) and 5 points, respectively. In one or two-stage revision THA, the average total score of the success cases was high compared with that of the failed case. There were significant differences of the average total score in success cases between the one and two-stage revision THAs (p<0.05).
Conclusions
A one-stage revision THA for deeply infected hip prosthesis should be performed on those cases who scored above 9 points, while a palliative operation may be indicated for those who scored under 5 points. However, it is difficult to forecast the recurrence using only this scoring system.
