Two-stage revision of late chronic periprosthetic hip joint infections

Abstract

Objective To explore the short-term and medium-term result of two-stage revision surgery in the treatment of late chronic periprosthetic joint infection (PJI) after hip replacement. Methods The retrospective study was conducted. Between January 2011 and January 2017, 27 patients (27 hips) of late chronic PJI after hip replacement in the Department of Orthopaedics, Xijing Hospital of Air Force Medical University were included. Among them, there were 7 males and 20 females. The age ranged from 52 to 77(63.9±5.5). One surgeon performed all surgeries in the study. At the clinical status analysis, radiographic evaluation, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were performed regularly to evaluate the stability of the prosthesis and to judge whether the infection was controlled. Harris score, Visual Analogue Score (VAS) and SF-12 score before and after operation were noted to evaluate the clinical efficacy. Results The present study included 27 patients. The follow-up time ranged from 2 to 7.8(4.0±1.5) years. During the follow-up, no signs of prosthesis loosening and osteolysis were found on X-ray.No local or systemic infection symptoms were found. The results of ESR and CRP were in the normal range. The infection control rate was 100%.No infection recurred. Compared with preoperative values, the mean VAS was reduced from 6.0±1.1 to 0.4±0.5. The mean Harris hip score was improved from 28.9±9.1 points to 80.4±11.3 points. The mean physical component summary and mental component summary score in SF-12 was improved from 23.0±2.8, 33.8±5.7 points to 39.3±7.3 and 51.7±10.3 points. The difference was statistically significant (t=2.580, 28.650, 10.683, 11.656, all P values<0.05) which proved that the short-term and medium-term clinical efficacy of this study was satisfactory. Conclusions Two-stage revision of the late chronic PJI is a safe and reliable procedure with high rates of infection control, prosthesis stability and satisfactory joint function in the short and medium-term follow-up. Key words: Arthroplasty, replacement, hip; Prosthesis-related infection; Reoperation