title: Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties.
abstract: Background and purpose - The use of uncemented revision stems is an established option in 2-stage procedures in patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, in 1-stage procedures, they are still rarely used. There are still no detailed data on radiological outcome after uncemented 1-stage revisions. We assessed (1) the clinical outcome, including reoperation due to persistent infection and any other reoperation, and (2) the radiological outcome after 1- and 2-stage revision, using an uncemented stem. Patients and methods - Between January 1993 and December 2012, an uncemented revision stem was used in 81 THAs revised for PJI. Patients were treated with 1- or 2-stage procedures according to a well-defined algorithm (1-stage: n = 28; 2-stage: n = 53). All hips had a clinical and radiological follow-up. Outcome parameters were eradication of infection, re-revision of the stem, and radiological changes. Survival was calculated using Kaplan-Meier analysis. Radiographs were analyzed for bone restoration and signs of loosening. The mean clinical follow-up time was 7 (2-15) years. Results - The 7-year infection-free survival was 96% (95% CI: 92-100), 100% for 1-stage revision and 94% for 2-stage revision (95% CI: 87-100) (p = 0.2). The 7-year survival for aseptic loosening of the stem was 97% (95% CI: 93-100), 97% for 1-stage revision (95% CI: 90-100) and 97% for 2-stage revision (95% CI: 92-100) (p = 0.3). No further infection or aseptic loosening occurred later than 7 years postoperatively. The radiographic results were similar for 1- and 2-stage procedures. Interpretation - Surgical management of PJI with stratification to 1- or 2-stage exchange according to a well-defined algorithm combined with antibiotic treatment allows the safe use of uncemented revision stems. Eradication of infection can be achieved in most cases, and medium- and long-term results appear to be comparable to those for revisions for aseptic loosening.
authors.affiliation: a Department of Orthopedics and Trauma Surgery and.
authors.forename: Philipp
authors.initials: P
authors.lastname: Born
authors.affiliation: b Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland , Liestal.|c Leonardo, Ärzte für Orthopädie und Traumatologie, Hirslanden Klinik Birshof , Münchenstein , Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ilchmann
authors.affiliation: b Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland , Liestal.
authors.forename: Werner
authors.initials: W
authors.lastname: Zimmerli
authors.affiliation: a Department of Orthopedics and Trauma Surgery and.
authors.forename: Lukas
authors.initials: L
authors.lastname: Zwicky
authors.affiliation: b Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland , Liestal.
authors.forename: Peter
authors.initials: P
authors.lastname: Graber
authors.affiliation: a Department of Orthopedics and Trauma Surgery and.|b Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland , Liestal.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Ochsner
authors.affiliation: a Department of Orthopedics and Trauma Surgery and.|b Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland , Liestal.
authors.forename: Martin
authors.initials: M
authors.lastname: Clauss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001843:Bone Cements; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011859:Radiography / Q000379:methods*; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements