title: A two stage re-implantation protocol for the treatment of deep periprosthetic hip infection. Mid to long-term results.
abstract: Deep periprosthetic hip infection is a devastating complication. Goal of treatment is infection eradication and durable functional reconstruction. Two-stage re-implantation is the standard of treatment. From January 1998 to December 2004 we treated 38 patients with an infected THA. There were 24 females and 14 males, with a mean age of 67 years (61-75). The infection occurred 13 months to 15 years (mean: 7.2 years) after the index operation. The mean follow-up was 11.6 years (7 to 14). 35 patients were available for review. Almost one third of the patients had been treated before with antibiotics. In 5 cases more than one pathogen were present. In 3 cases, it was not possible to isolate a causative organism. In 15 cases (43%), a resistant pathogen was isolated. We used a two stage re- implantation protocol. Spacer was not used in any of the cases. Femoral revision was performed with uncemented implants, 21 of distal (wagner type) fixation and 14 of modular type with proximal fixation. 24 press fit shells (17 oTMT cups) and 11 Muller rings were used. In 33 cases (94%) eradication of infection was achieved. The mean HHS improved from a mean of 38.2 preoperatively to a mean of 88.6 at final follow-up (p<0.001). There was no case of implant loosening or migration. Chronic late infection can be managed successfully with a two stage re-implantation protocol, without interim spacer, including neglected cases, previous long term antibiotics and cases with resistant pathogens.
authors.affiliation: D Department of Orthopaedics, KAT Hospital, Athens - Greece. gmacheras@gmail.com
authors.forename: George A
authors.initials: GA
authors.lastname: Macheras
authors.forename: Stefanos D
authors.initials: SD
authors.lastname: Koutsostathis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kateros
authors.forename: Stamatios
authors.initials: S
authors.lastname: Papadakis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Anastasopoulos
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D020127:Recovery of Function; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents