Cementless two-staged total hip arthroplasty with a short term interval period for chronic deep periprosthetic infection. Technique and long-term results

Abstract

The two-staged exchange with delayed reimplantation is the most reliable method to treat a deep periprosthetic infection after a total hip arthroplasty (THR). Nether uniform recommendations for the technique of cementless reimplantation, nor long term clinical and radiological results are reported. Our protocol is performed under short term antibiosis with cementless primary porous hip implants to treat chronic deep periprosthetic infections following THR. A retrospective study was performed to evaluate the clinical and radiological long term outcome and the rate of persistent infection of 14 patients. In a five year minimum follow up persistent infection was observed twice in a two-staged revision THR. A dislocation of the hip components was observed in three cases, and could be surgically treated in twice and by wearing a hip-brace in one case. We could not find a loosening of THR components. Three patients had a good or excellent, 11 patients a fair or bad functional outcome. There was a significant correlation between functional outcome and length of interval of prosthesis exand reimplantation. Patients have an increased comfort resulting from a short, CRP depending time interval between ex- and reimplantation. Functional outcome is the better the shorter the interval is. The reinfection rate is comparable to those of cemented revision THR's with a long term interval. We could observe advantages in a reduced amount of bone loss and better osseous integration of the uncemented implants, compared to cemented implants reviewing literature. Alterations of acetabular bone stock and soft tissue are responsible for a high rate of instability of the THR. An inaccurate gait pattern is caused by gluteal weakness in the majority of patients. Repeated surgical intervention and duration of immobilization have to be minimalized.