Abstract
Two-staged revision including removal of all components is a common approach for treatment of infected THA. However, removal of well-fixed femoral stems can result in bone loss and compromised fixation. An alternative in selected cases is partial two-stage exchange, in which the well-fixed femoral stem is left in situ, only the acetabular component is removed, the joint space is debrided thoroughly, a spacer is placed, IV antibiotics are administered during the interval, and delayed reimplantation is performed.
We recently reported our results using the technique of partial two-stage exchange of infected THA. From 2000 through January 2011 in 19 patients with infected THA treated with partial two-stage exchange including complete acetabular component removal, aggressive soft tissue debridement, retention of the well-fixed femoral stem, placement of an antibiotic-laden cement femoral head on the trunnion of the retained stem, postoperative course of antibiotics, and delayed reimplantation. Indications for this treatment included those patients whose femoral component was determined to be well fixed and its removal would result in significant femoral bone loss and compromise of future fixation. During the study period, this represented 7% (19 of 262) of the patients whom we treated for a chronically infected THA. Minimum follow-up was 2 years (mean, 4 years; range, 2–11 years). None of the 19 patients in this series were lost to followup. We defined failure as recurrence of infection in the same hip or use of long-term suppressive antibiotics.
Two patients (11%), both with prior failure of two-staged treatment of infection, failed secondary to recurrence of infection at an average of 3.3 years. There were no patient deaths within 90 days. Postoperative Harris hip score averaged 68 (range, 31–100).
As 89% of patients in this series were clinically free of infection at a minimum of 2 years, we believe partial two-stage exchange may represent an acceptable option for patients with infected THA when femoral component removal would result in significant bone loss and compromise of reconstruction. Further study is required on this approach.
