title: A multidisciplinary team approach to two-stage revision for the infected hip replacement: a minimum five-year follow-up study.
abstract: We report the five year outcomes of a two-stage approach for infected total hip replacement. This is a single-surgeon experience at a tertiary centre where the more straightforward cases are treated using single-stage exchange. This study highlights the vital role of the multidisciplinary team in managing these cases. A total of 125 patients (51 male, 74 female) with a mean age of 68 years (42 to 78) were reviewed prospectively. Functional status was assessed using the Harris hip score (HHS). The mean HHS improved from 38 (6 to 78.5) pre-operatively to 81.2 (33 to 98) post-operatively. Staphylococcus species were isolated in 85 patients (68%). The rate of control of infection was 96% at five years. In all, 19 patients died during the period of the study. This represented a one year mortality of 0.8% and an overall mortality of 15.2% at five years. No patients were lost to follow-up. We report excellent control of infection in a series of complex patients and infections using a two-stage revision protocol supported by a multidisciplinary approach. The reason for the high rate of mortality in these patients is not known.
authors.affiliation: University College London Hospitals, 235 Euston Rd, London NW1 2BU, UK.
authors.forename: M S
authors.initials: MS
authors.lastname: Ibrahim
authors.affiliation: London Hospital, Barts Health NHS Trust, Royal Whitechapel, London E1 1BB, UK.
authors.forename: S
authors.initials: S
authors.lastname: Raja
authors.affiliation: The Royal Sussex County Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Khan
authors.affiliation: University College London Hospitals, 235 Euston Rd, London NW1 2BU, UK.
authors.forename: F S
authors.initials: FS
authors.lastname: Haddad
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D003646:Debridement / Q000379:methods; D020878:Device Removal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011379:Prognosis; D011446:Prospective Studies; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000601:surgery*; D016059:Range of Motion, Articular; D012086:Reoperation; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D013210:Staphylococcus / Q000302:isolation & purification; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Periprosthetic infection; Revision surgery; Total hip replacement