title: Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study.
abstract: BACKGROUND
  Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol.
  
  
  METHODS
  Nineteen patients (20 hips) were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS]) and hip joint function (Harris Hip score).
  
  
  RESULTS
  The mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104) months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84) pre-operatively to 18 (range, 0 - 38) prior to spacer removal and to 8 (range, 0 - 15) at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment.
  
  
  CONCLUSIONS
  Satisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.
authors.affiliation: Dipartimento di Chirurgia Ricostruttiva e delle Infezioni Osteo-articolari Istituto Ortopedico I,R,C,C,S, Galeazzi, Milano, Italy. carlo.romano@grupposandonato.it
authors.forename: Carlo L
authors.initials: CL
authors.lastname: Romanò
authors.forename: Delia
authors.initials: D
authors.lastname: Romanò
authors.forename: Enzo
authors.initials: E
authors.lastname: Meani
authors.forename: Nicola
authors.initials: N
authors.lastname: Logoluso
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Drago
mesh_terms: D000328:Adult; D000368:Aged; D001170:Arthritis, Infectious / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D015331:Cohort Studies; D005260:Female; D025981:Hip Injuries / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome