Abstract
Few studies provide an analysis of conservative two-stage revision of hip periprosthetic joint infection (PJI) and its impact on final outcome. A conservative revision is defined when soft tissues and bone quality enable the use of primary prosthetic components. Data of patients treated for chronic hip PJI who underwent two-stage revision between 2009 and 2016 and had a minimum of 2 years of follow-up were collected. Oxford Hip Score (OHS), Harris Hip Score (HHS) and radiological and microbiological data were retrieved and analysed. Clinical and functional outcome, survival, mortality, eradication, reinfection and re-revision rates within subgroups of patients with primary components and revision components are reported herein. A total of 148 patients underwent two-stage hip exchange with a mean follow-up of 55.6 ± 23.1 months and a mean age at surgery of 64.3 ± 12.7 years. Forty-four percent of patients underwent conservative revision. The mean HHS significantly improved from 40.6 ± 9.4 points to the final value of 87.8 ± 10.5 points (p = .002), and the mean OHS went from 20.3 ± 3.8 points to 40.3 ± 5. points (p< .001). Patients who were treated with primary components or isolated revision stems in the second stage had a significant reduction in surgical times (p< .001). The mortality rate for all causes of death was 6.8%, the eradication rate was 89.9%, the reinfection rate was 4.7% and the reoperation rate was 7.4% without differences between conservative and non-conservative revisions. Two-stage exchange arthroplasty for total hip arthroplasty (THA) PJI is a good strategy that provides satisfactory results, high eradication rates and no further need for revision. The conservative two-stage revision in patients with adequate bone stock represents a feasible option with good results and survival rates.
Highlights
Periprosthetic joint infection (PJI) is one of the most common and devastating complications after total hip arthroplasty (THA), occurring in approximately in 1% of cases [1, 2]
The aim of the present study is to provide data on the clinical, radiological and microbiological outcomes of patients treated for PJI after total hip replacement with conservative twostage exchange with primary components
The mean body mass index (BMI) was 26.5 ± 5.2 kg/m2, and 14 (9.5%) patients were classified as obese (BMI> 30)
Summary
Periprosthetic joint infection (PJI) is one of the most common and devastating complications after total hip arthroplasty (THA), occurring in approximately in 1% of cases [1, 2]. The explantation during the first-stage represents a technical challenge especially with regard to femoral and acetabular bone stock. A conservative revision is defined when soft tissues and bone quality enable the use of primary prosthetic components. The main advantages of standard implants in revision surgery are the reduced invasiveness, the shorter operative times and preserved bone stock. In case of severe bone deficit, a second-stage reconstruction could be extremely difficult to manage with standard implants and revision components are required [7,8,9]
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