Two-staged surgical treatment of hip septic arthritis

Abstract

Hip arthritis (coxitis) is the inflammatory process in the hip, requiring complicated and lengthy treatment. At some cases it is associated with serious complications, up to patient’s disability due to the femoral head destruction. The treatment goal is to halt inflammation for further hip arthroplasty and functional rehabilitation. Arthroplasty is performed using the commercially available cement antibiotic-impregnated articulating spacers. The article reviews a number of clinical examples of two-staged surgical treatment of hip septic arthritis using articulating spacers with further hip arthroplasty. Experts, including native specialists, in the periodicals and clinical practice question the effectiveness of two-staged treatment. The experience of effective use of commercially available bone cement antibiotic-impregnated articulating spacers is presented. The method allows to halt the inflammation, to avoid the significant femoral shortening and acetabulum filling by scar tissue, to preserve hip function and provides the patient an opportunity to move with a partial load on the operated limb while waiting for the arthroplasty, as well as improves the conditions for hip implant consolidation. After suppressing the inflammation, the described method, providing a moderate load on the affected bone, enhances the bone mineral density increase both of femur and acetabulum. Two-staged treatment of septic coxitis decreases the risk for infective complications after the total hip replacement.