Introduction and objective: Infection is one of the greatest threats in hip surgery. It is agreed that the implant should be removed. The debate remains open if one or two stage surgery is perferable. This study evaluates the two stage septic hip revison arthroplasty and compares our results with the literature.

Materials and Methods: A retrospective clinical and radiological study was performed on patients that had a two stage septic revision hip surgery. The Harris Hip Score (HHS) and the Mayo Hip Score (MHS) were applied. The ASA-Score for evaluation of preoperative morbidity was introduced. Statistical evaluation included the t–test.

Results: 40 patients with 41 primary total hip replacements underwent septic revision. 17 patients with 18 hip prostheses (8 male, 9 female) could be evaluated. 14 patients were deceased, the rest was unable to participate due to severe health problems.12 patientswith 13 hips had a primary reimplantation, 5 patients had to be left with a Girdlestone situation. The mean follow up was 52 months (4.3 years, standard error +/−28). The average age was 68 years. The mean preoperative ASA-Score was 3.24 (+/−0,75). Staph. aureus was the most common infectious agent (35%) followed by Staph epidermidis (24%) and E. coli (12%). The mean time between removal and re-implantation was 158 days. The most frequent primary preoperative indication for hip arthroplasty was osteoarthritis (62%) followed by trauma (24%) and avascular necorsis of the femoral head (14%). In 42%, the onset of ionfection was early (under 12 months after implantation), 58%% of the patients had a late onset infection. The MHS in the group who had a reimplantation was an average of 66/standard error +/−21). The patients with a Girdlestone situation had a HHS that was not significantly lower than the rest (58 in Girdlestone patients, 61 in patients with re-implantation).

Discussion: The study demonstrated that our results compare well to those of other studies. It supports the conclusion that two stage septic hip arthroplasty is still an excellent option in septic revision arthroplasty. The preoperative ASA-Score which is not routinely mentioned in other studies showed that many of our patients were critically ill. This may explain the long interval between removal and reimplantation, and it may also be of value to determine wether to re-implant at all costs. This study remarkably demonstrated that patients with resection arthroplasty did not have a significantly lower HHS than those with performed re-implantation. The resection arthroplasty may be considered a valuable solution in clinically very ill patients according to our results. If a second operation considering the ASA -score would be too risky it should be discussed if reimplantation must be achieved.

We examined 52 patients with acute Achilles tendon rupture (ATR), 43 men and 9 women, with a median age of 43 (28–68) years after percutaneous Achilles tendon repair with early functional therapy. 11 patients were treated in a cast (C) and 41 had a specially designed shoed (S). The mean follow-up was 56 (36–95) months. Patients suffering from health problems, which could affect their gait and balance (e.g. OA, spinal stenosis,…), as well as patients suffering from complications postoperatively, were excluded from the study. The mean Hannover Achilles Tendon Score was 81 (50 – 95) points (C = 81, S = 81).

Their calf muscle function studied three to eight years after treatment were found to have a significantly impaired dynamic muscle function of the calf muscles when tested in a specially constructed heel-raise test device. The Wilcoxon matched-pairs signed-ranks test showed a two-tailed P value of < 0,0001.

The average calf size was 38 (31–46,5) cm on the uninjured side and 36 (32–44,5) cm on the injured side. Only two patients had an equal calf size. Comparing the uninjured and injured side the two-tailed P value was found to be extremely significant < 0,0001.

The correlation between the maximum force and functional heel raise testing to the calf size on the injured side was weak with a Spearman correlation coefficient (r) = 0,33–38. There was no difference found between the patients treated in a cast and the patients treated in a shoe with percutaneous Achilles tendon repair and early functional therapy.

The principle finding in the present study was that the impact of an ATR is of great importance for the functional outcome than the treatment that is given. The difference in flexion strength and endurance between the injured and the uninjured side remained even after a 56 months follow-up. Therefore, calf size and functional muscle testing is a good tool to test functional outcome after Achilles tendon rupture. However, there was only a weak correlation between the size of atrophy and the amount of force reduction.