[Clinical study on second-stage revision in the postoperative infection after total hip replacement].
OBJECTIVE
To study the therapeutic effects and clinical experiences of second-stage revision in postoperative infection after total hip replacement and to explore its security and validity.


METHODS
From January 2006 to March 2009, 17 hips in 17 patients (7 males and 10 females, ranging in age from 43 to 75 years, with an average of 58.5 years) were treated with second-stage revision. All the patients suffered from different degrees of hip pain. In bacilliculture of Synovial fluid or peritonsillar tissue, 11 patients showed positive results and 6 patient negative. The intraoperative periprosthetic histopathological examination showed that all the patients had acute inflammation. Eight patients had sinus communicating with prosthesis; 15 patients had increased ESR, and 15 patients had C reactive protein increased. All the patients had osteolysis, prosthesis loosening, and the performance of periosteal reaction in X-ray. All the patients were treated with second stage revision. In the first operation, thorough debridement was perfumed and the prosthesis was removed. Then the prosthesis of antibiotic--loaded acrylic cement was implanted. After giving antibiotics intravenously for 4 weeks, the antibiotics were taken orally for another six weeks. The ESR and C response protein were examined at regular time, and the second-stage revision surgery was perfumed when the ESR and C response protein were normal. The Harris score was used to evaluate therapeutic effects of second-stage revision surgery before and after treatment.


RESULTS
All the patients were followed up with an average of 19.5 months, ranged from 12 to 35 months. No complications occurred. Postoperative X-ray showed prosthesis in the correct position. The Harris score increased from preoperative (39.3 +/- 5.6) to postoperative (84.4 +/- 10.3) (t = 15.86, P < 0.01).


CONCLUSIONS
The second-stage revision in postoperative infection after total hip replacement has a good efficacy, safety and reliability advantages. This technology provides an alternative in postoperative infection after total hip replacement.
Dong
Yi-Long
YL
Department of Orthopaedics, Third Affiliated Hospital of Wenzhou Medical College, Ruian 325200, Zhejiang, China. dongyilongdel@sina.com
Yang
Guo-Jing
GJ
Lin
Rui-Xin
RX
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*
D000900:Anti-Bacterial Agents