Abstract
Aim
Periprosthetic joint infections (PJI) are a severe complications after hip arthroplasty. The infections rate ranges from 0.7 to 1.3 depending on different reports. The aim of the present study is to evaluate the radiological and clinical outcome of patients that underwent two-stage revision for the treatment of periprosthetic joint infection of the hip when an extended trochanteric osteotomy (ETO) was necessary to remove the femoral stem.
Methods
We retrospectively analyzed data from 84 patients that underwent two-stage revision of the hip between January 2006 and December 2010 at our institution. In forty-nine patients (Group A, 58.3%), the femoral stem was removed without an ETO, while in the remaining thirty-five patients (Group B, 41.7%) an ETO was necessary. In each case a metallic cerclage was used to closure of the flap. The average age for patients in group A was 64.3 years, while the average age in patients in group B was 66.4 years. The mean follow-up was respectively 117 months in group A and 122 months in group B. Eight patients died before the last follow-up, and data from six patients were incomplete. Complications, radiological and clinical outcome were. Mann Whitney U Test and Chi Square Test were used respectively to analyze continues and categorical variables. Cumulative survival of the implants was calculated for reinfection and mechanical complications with Kaplan-Meyer curves.
Results
The mean follow-up was 118 months. The cumulative incidence of reinfection was 4.7% at 1 years and 10.7 at last follow-up. No statistically significant (p-value > 0.05) differences were observed in the two groups neither at 1 year nor at last follow up. The cumulative incidence of mechanical complication was 3.6% at 1 year and 8.3% at last follow-up. No statistically significant differences (p-value > 0.05) were observed in the two groups neither at 1 year nor at last follow up. All the patients had the healing of the ETO at six months (mean 11.4 weeks). The mean Harris Hip Score was 77.5. No statistically significant (p-value > 0.05) differences were observed in the two groups.
Discussion
The results obtained in this retrospective study demonstrates that there is no difference in terms of reinfection-rate, mechanical complications and clinical outcome in patients that underwent two-stage revision with or without an ETO. In presence of a well-fixed femoral stem, performing an ETO could be helpful to expose the femoral canal facilitating the femoral stem's removal avoiding intra-operative femoral fracture.
