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Partial Two-stage Exchange for Infected Total Hip Arthroplasty

February 01, 2014

Contributors: Timothy Ekpo, DO; Keith R Berend, MD; Michael J. Morris, MD; Joanne B Adams, BFA, CMI; Adolph V Lombardi Jr, MD; Adolph V Lombardi Jr, MD

Two-stage revision including removal of all components is a common approach for treatment of infected total hip arthroplasty (THA). However, removal of well-fixed femoral stems can result in bone loss and compromised fixation. An alternative in selected cases is partial two-stage exchange, in which the well-fixed femoral stem is left in situ, only the acetabular component is removed, the joint space is débrided thoroughly, a spacer is placed, intravenous antibiotics are administered during the interval, and delayed reimplantation is performed. We recently reported our results using the technique of partial two-stage exchange of infected THA.1 Between 2000 and January 2011, 19 patients with infected THA were treated with partial two-stage exchange including complete acetabular component removal, aggressive soft-tissue débridement, retention of the well-fixed femoral stem, placement of an antibiotic-laden cement femoral head on the trunnion of the retained stem, a postoperative course of antibiotics, and delayed reimplantation. Patients were indicated for treatment if their femoral component was determined to be well fixed and its removal would result in significant femoral bone loss and compromise of future fixation. During the study period, this population represented 7% (19 of 262) of patients treated for a chronically infected THA. Minimum follow-up was 2 years (mean 4 years; range, 2-11 years). No patient in this series was lost to follow-up. We defined failure as recurrence of infection in the same hip or use of long-term suppressive antibiotics. Two patients (11%), both with prior failure of two-stage infection treatment, failed secondary to recurrence of infection at an average of 3.3 years. There were no patient deaths within 90 days. Postoperative Harris hip score averaged 68 (range, 31-100). Because 89% of patients in this series were clinically free of infection at a minimum of 2 years, we believe partial two-stage exchange may represent an acceptable option for patients withinfected THA when femoral component removal would result in significant bone loss and compromise of reconstruction. Further study is required on this approach.

Results for "Revision Hip Arthroplasty"

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