Treatment of periprosthetic hip infection with retention of a well-fixed stem: six to 13-year outcomes

Takuya Otani,Motoi Takahashi,Tetsuo Hayama,Hideki Fujii,Keishi Marumo,Toshiomi Abe,Yasuhiko Kawaguchi

doi:10.1186/s42836-019-0002-8

Abstract

BackgroundTreatment of periprosthetic joint infection (PJI) is challenging, generally requiring complete implant removal. However, recently reported treatments involve partial retention of implants because of the severe local and systemic burden on the patients and difficulties in functional preservation. Long-term results should be evaluated because of the risk of residual biofilm on the retained implant and late infection recurrence. We evaluated 6 to 13-year clinical outcomes of two-stage treatment of chronic PJI retaining well-fixed cementless stems.MethodsAmong 36 surgeries for deep infection following hip arthroplasty performed from 2004 to 2011, six hips had a well-fixed and well-functioning cementless stem. These six hips were all chronic PJI and were treated without stem removal. The first-stage surgery involved acetabular cup removal and reconstruction by filling the acetabular defect with antibiotic-loaded acrylic cement, creating a socket-like hemispherical dent, and reducing the retained femoral head to this dent. After confirming infection eradication the second-stage acetabular reconstruction was performed. One patient died of an unrelated noninfective cause 1 year after the operation. Clinical outcomes of the remaining five patients were followed for 6 to 13 years.ResultsBetween the two surgeries (range; 2–5 months), patients underwent active range-of-motion and ambulation exercises. No dislocation was found during the interval. No recurrence of infection was found and good functional outcomes and radiographic findings were observed during the average follow-up of 109 months in all five patients.ConclusionsTwo-stage treatment with retention of a well-fixed stem may minimize local and systemic burden of the patient and enhance functional preservation while obtaining long-term infection control. Although further study could establish the effectiveness and indications for this treatment option, currently used indications should be carefully evaluated considering factors including local and systemic conditions of the patient, implant fixation status, and type of bacteria.

Highlights

Treatment of periprosthetic joint infection (PJI) is challenging, generally requiring complete implant removal
But a two-stage treatment that involves the complete removal of implants in the first surgery and infection-free reconstruction in the second surgery is considered the
Problems associated with one-stage treatment are that the indications are currently unclear, infection eradication rate could be slightly lower compared with two-stage treatment, and invasiveness of the surgical procedure is extremely high

Summary

Introduction

Treatment of periprosthetic joint infection (PJI) is challenging, generally requiring complete implant removal. Several studies have reported a treatment strategy involving partial retention of implants as an additional treatment option for PJI: two-stage treatment with retention of well-fixed cementless implants [11,12,13,14,15], two-stage treatment with retention of well-fixed cement mantles [16], and single-stage treatment with retention of wellfixed implants [17] These procedures were developed to preserve the function of the hip joint while reducing the local and systemic burden during treatment, but their detailed methods and effectiveness have not been verified or established. More importantly, even though short-term treatment outcomes are preferable, these treatment options require long-term follow-up because these methods have the risk of residual biofilm and late infection recurrence

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Discussion

Conclusion