[Reimplantation of a hip prosthesis in patients with an infected resection arthroplasty].
OBJECTIVE
Resection arthroplasty is an accepted surgical option to treat severe late periprosthetic infections. However, it is known that one has to consider that a persistence of infection is very often combined with a permanent fistula in approximately 10 % of the patients. In particular, the occurrence of a fistula and pain caused by the persistent infection is followed by a considerable reduction of the quality of life of these patients. We have analysed the effort and complications of treatment and the change of pain and function of these patients.


METHODS
In this study 11 patients (average age 68 years) with a Girdlestone situation and persistent infection with an average duration of 33 months were successfully treated by a multiple stage surgical therapy plan which included a radical surgical revision of the infection, stepwise leg lengthening and subsequent reimplantation. In all cases surgical revision of the infection was supported by both systemic and local (antibiotic-loaded cement spacer) antibiotic therapy. The choice of implants followed the general recommendations for revision hip arthroplasty.


RESULTS
The mean follow-up after reimplantation was 16 months (min 4, max 24). We observed an average improvement of the Harris hip score from 27.7 points at the beginning of the therapy to 72.5 points at the end of the follow-up. None of the patients had suffered from a reinfection at the end of the follow-up. We observed no surgically related mortality. Surgical complications including spacer dislocations and implant dislocation were seen. The leg length discrepancy could be decreased from an average of 6.8 cm to 1 cm without the occurrence of a neurological deficit.


CONCLUSIONS
The reimplantation of a hip prosthesis in cases of infected Girdlestone situations is complex, it can, however, offer the prospect of a marked increase in function and less pain for these patients.
Klinik für Unfall-, Wiederherstellungs- und Plastische Chirurgie, Universitätsklinikum Leipzig AöR. stefan.klima@medizin.uni-leipzig.de
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Klima
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Josten
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000601:surgery*; D012092:Replantation / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
Die Reimplantation eines künstlichen Hüftgelenkes bei septischer Girdlestone-Situation.