Septic versus aseptic hip revision: how different?
BACKGROUND
The few available studies directly comparing aseptic and septic joint revision surgery report conflicting results. We investigated whether two-stage revision of septic hip prosthesis with a preformed antibiotic-loaded spacer and an uncemented prosthesis provides hip function and quality of life similar to those provided by aseptic revision surgery in the medium term, as well as the associated direct hospital costs.


METHODS
We prospectively evaluated the hip function (Harris hip score) and quality of life (WOMAC and SF-12 scores) of 80 patients who underwent one-stage revision for aseptic loosening (Group A, 40 patients) or two-stage revision for septic total hip prostheses (Group S, 40 patients). Patients were matched for gender, age, and bone loss. A preformed antibiotic-loaded cement spacer was used for two-stage revision, and uncemented modular prostheses were implanted at revision in both groups. The minimum follow-up was 2 years (average 4 years; range 2-6 years).


RESULTS
We found no difference in infection recurrence or aseptic loosening rate in the two groups. Average Harris hip score increased similarly in both groups: from 19.1 to 74.0 in Group A versus 15.0-71.2 in Group S. Patient-reported quality-of-life questionnaires (SF-12 and WOMAC) at last follow-up were similar postoperatively, but the complication rate for Group S was twice that of Group A (20.8 versus 10%). Mean overall hospital-related costs of two-stage procedures were 2.2 times greater than those for aseptic revisions.


CONCLUSIONS
Two-stage revision for infected hip prostheses, using a preformed antibiotic-loaded cement spacer and uncemented revision prosthesis, offers a success rate comparable to noninfected revisions in the medium term but is associated with a higher complication rate and costs.
Romanò
Carlo Luca
CL
Dipartimento di Chirurgia Ricostruttiva e delle Infezioni Osteo-articolari, Istituto Ortopedico IRCCS Galeazzi, 4-20166 Milan, Italy. carlo.romano@grupposandonato.it
Romanò
Delia
D
Logoluso
Nicola
N
Meani
Enzo
E
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D001843:Bone Cements; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D007558:Italy; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D012016:Reference Values; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D001843:Bone Cements
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