Partial two-stage exchange for periprosthetic joint infection after total hip arthroplasty

Abstract

Objective To evaluate the early stage effects of partial two-stage exchange (PTE) for infection after total hip arthroplasty (THA) in order to improve surgical treatment outcomes. Methods Twelve patients (7 males and 5 females) of infected THA treated by PTE between September 2000 and February 2016 were included with an average of 59 years old (range, 40-74 years old). The femoral stem prosthesis was preserved when we ensured that it was not infected and with well fixation during operation. The acetabular prosthesis was totally replaced. Furthermore, the secondary surgery was performed on patients who were free from infection for at least 3 months. At the follow-up duration, the pelvic X-ray was examined to access the presence of loosening of the prosthesis. The inflammatory index was recorded. Hip function was assessed by the Harris hip score, and the visual analogue score (VAS) and patient's subjective satisfaction were recorded by the questionnaire. Results All of the 12 patients were followed up for a mean of 33.3 months (range, 24-48 months). We achieved a 92% (11/12) success rate. One patient resuffered infection, which was controlled after the second debridement. The preoperative Harris score of 12 patients was 23-57, with an average of 40.83±10.62. All patients had significant improvement in hip function after PTE. The Harris score reached 59.58±4.34 at one month after surgery, and reached 64.58±9.08 after three months and 86.75±4.58 at the last follow-up. There was significantly different when compared with the preoperative Harris score. At the last follow-up, the length difference between the lower limbs was less than 1cm in all patients. Two patients did not complain of pain, while other 10 patients got a VAS score of less than 2 points. The patient's subjective satisfaction rating was 100%. Conclusion PTE could be a valuable alternative treatment for infection after THA. The infection control rate and clinical outcomes are comparable to those of two-stage exchange. Key words: Arthroplasty, replacement, hip; Prosthesis-related infections; Device removal