Abstract
The failure of any joint arthroplasty secondary to infection is devastating to both patient and surgeon. Eradication of infection is the primary treatment objective. Classic teaching has called for removal of all prosthetic components, thorough soft tissue and bone debridement and either immediate or delayed reimplantation with an interim antibiotic polymethylmethacrylate laden spacer. The presence of a residual biofilm on implants is a rationale for component removal. Several sophisticated removal systems have been developed for the acetabulum which facilitate component removal with minimal to no bone loss. However, such systems do not exist for the femoral component. Removal of well-fixed femoral components remains a significant challenge frequently requiring extensive osteotomies which can result in bone loss and compromise of future femoral component fixation. Therefore, it would seem attractive to leave a well fixed femoral component in situ and remove only the acetabular component, perform a thorough debridement, place an antibiotic laden polymethylmethacrylate spacer within the acetabulum and perform a delayed reimplantation. A retrospective analysis of our practice from 2000 to 2010 revealed nineteen patients treated with a partial radical debridement and delayed reimplantation with a minimum of two year follow-up. There were no patient deaths within 90 days. Follow-up averaged 3.9 years. Three patients expired during the study period at an average of 3.5 years post-operative. Two patients, both multiply revised with prior 2-stage treatment of infection, failed secondary to recurrence of infection at an average of 3.3 years. Our results suggest that partial radical debridement represents an acceptable option for patients with infected THA. We have employed this technique when it was deemed that removal of the femoral component would require extensive osteotomy resulting in significant bone loss and compromise of future femoral reconstruction. It has been successful 89% of the time. We are aware that further study is required and we remain cautiously optimistic regarding this treatment modality.
