title: Retaining well-fixed cementless stem in the treatment of infected hip arthroplasty.
abstract: OBJECTIVE
  Two-stage reconstruction, reimplantation after removal of an infected prosthesis, has been considered to be the gold standard for treatment of infected hip arthroplasty. However, during the removal of a well-fixed femoral stem, the proximal femur can be damaged and a sequestrum can be formed, which might lead to chronic osteomyelitis and difficulty in reimplantation. We wanted to determine whether infection after hip arthroplasty can be treated without removal of a well-fixed stem.
  
  
  METHODS
  We treated 19 patients who had an infection after hip replacement, but a well-fixed cementless stem, with 2-stage reconstruction. At the first stage, we removed the acetabular cup, the liner and the head, but not the stem. We then implanted a cup of cement spacer. After control of infection, we reimplanted the acetabular component and head.
  
  
  RESULTS
  2 patients did not undergo second-stage reconstruction because they were satisfied with the pain relief and the activity that they had with the cement-spacer implantation. The remaining 17 patients underwent the second-stage of the reconstruction using cementless arthroplasty. At a mean follow-up time of 4 (2-8) years, 15 of the patients had no recurrence of infection, with satisfactory clinical and radiographic outcome.
  
  
  CONCLUSIONS
  This second-stage reconstruction after retention of the stem could be an alternative treatment option for periprosthetic infection with a well-fixed stem.
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea.
authors.forename: Young-Kyun
authors.initials: YK
authors.lastname: Lee
authors.forename: Kee Haeng
authors.initials: KH
authors.lastname: Lee
authors.forename: Jae-Hwi
authors.initials: JH
authors.lastname: Nho
authors.forename: Yong-Chan
authors.initials: YC
authors.lastname: Ha
authors.forename: Kyung-Hoi
authors.initials: KH
authors.lastname: Koo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D002484:Cementation; D020878:Device Removal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome