title: Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection?
abstract: BACKGROUND
  Methicillin-resistant hip infections are increasingly common. Reports of the surgical management of these patients using two-stage THA show variable control of infection, but all reports used static spacers.
  
  
  OBJECTIVE
  We therefore determined (1) the rate of successful control of infection and (2) function in patients with methicillin-resistant infection treated with a two-stage THA using an articulated cement spacer during the first stage.
  
  
  METHODS
  We retrospectively reviewed 50 patients who had a two-stage revision THA for methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis infection. Twelve patients died, leaving 38 for review. All eligible patients completed quality-of-life outcome questionnaires (WOMAC, SF-12, Oxford-12, UCLA activity score, hip and knee satisfaction score). Minimum followup was 24 months after the second stage (mean, 58 months; range, 24-123 months).
  
  
  RESULTS
  Of the 38 patients, eight (21%) had recurrence of their infection requiring further revision surgery. Of the remaining 27 patients, the mean WOMAC was 62, mean Oxford-12 60, mean UCLA activity score 4.3, and mean hip and knee satisfaction score 66.
  
  
  CONCLUSIONS
  We found a treatment failure rate of 21% for patients with methicillin-resistant S. aureus or methicillin-resistant S. epidermidis infection. This is a higher rate than reported for two-stage THA for studies including patients infected with both nonresistant and resistant organisms. The functional scores for patients were also lower than those reported in the literature.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada.
authors.forename: Fay
authors.initials: F
authors.lastname: Leung
authors.forename: Corey J
authors.initials: CJ
authors.lastname: Richards
authors.forename: Donald S
authors.initials: DS
authors.lastname: Garbuz
authors.forename: Bassam A
authors.initials: BA
authors.lastname: Masri
authors.forename: Clive P
authors.initials: CP
authors.lastname: Duncan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation; D001843:Bone Cements / Q000627:therapeutic use; D001955:British Columbia; D016009:Chi-Square Distribution; D005260:Female; D006621:Hip Joint / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity*; D008875:Middle Aged; D017060:Patient Satisfaction; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D011788:Quality of Life; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013212:Staphylococcus epidermidis / Q000472:pathogenicity*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements