Clinical outcome of extended trochanteric osteotomy in two-stage revision of periprosthetic hip infection

Abstract

Objective To investigate the efficacy of using an extended trochanteric osteotomy as part of a two-stage exchange procedure for periprosthetic hip infection. Methods We retrospectively analyzed 16 patients (16 hips) including 9 males and 7 females who had extended trochanteric osteotomy as part of two-stage revision procedure for periprosthetic hip infection from January 2008 to January 2012, the average age was 65.2±6.4 years at the time of operation. The two-stage revision protocol included taking out of all implants using extended trochanteric osteotomy, meticulous debridement, restoration of the osteotomies and fixed with cerclage wiring, implantation of antibiotic bone cement spacer in first stage. After sequential therapy of antibiotics through peripheral vein and enteral prescription, the prosthesis was implanted in the second stage. Harris hip score was used to evaluate the hip function. X-ray radiograph was conducted to evaluate the healing of osteotomy, eradication of infection, prosthesis stability, displacement and looseness. Results All patients were followed-up for 24-90 months (53.4±7.2 months on the average). The interval between the first and second surgery was 8.6±2.1 months with a range from 5-18 months. All osteotomies healed uneventfully, with the average heal time 13.2 ± 1.3 weeks (range from 8 to 16 weeks). The infection was eradicated in 15 hips (93.8%) at the second surgery. One hip with staphylococcus epidermidis infection was confirmed by bacterial culture of synovial fluid in second surgery. Infection symptom disappeared after sequential antibiotic therapy. At the last follow-up, all patients had successful eradication of infection, with Harris score improved from 38.6 ± 5.4 preoperatively to 86.4 ± 3.2. Thirteen patients achieved bone ingrowths, while the other 3 patients had fibrous ingrowths. Two cases had intraoperative fracture, 2 had postoperative spacer dislocation. Conclusion Extended trochanteric osteotomy as part of a two-stage exchange arthroplasty can be performed safely and effectively in periprosthetic hip infection, with reliable osteotomy healing. Furthermore, it does not influence the effects of infection treatment and component stability. Key words: Arthroplasty, replacement, hip; Osteotomy; Prosthesis-related infections; Reoperation