title: Functional outcomes of infected hip arthroplasty: a comparison of different surgical treatment options.
abstract: BACKGROUND
  Periprosthetic joint infection (PJI) following total hip arthroplasty (THA) can be treated with irrigation and debridement with head and polyethylene exchange (IDHPE) or 2-stage revision (2SR). Few studies have compared patient-reported outcome measures (PROMs) in patients managed with these treatments.
  
  
  METHODS
  A retrospective review identified 137 patients who had an infected primary THA between 1986-2013. Control cohorts were matched according to age and Charlton Comorbidity Index (CCI). Harris Hip Scores (HHS), Short Form 12 (SF12), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were compared between the control and infected cohorts.
  
  
  RESULTS
  68 patients underwent a 2SR and 69 patients underwent an IDHPE. IDHPE had a 59% success rate in eradicating infection. PROMs for the 2SR cohort were significantly worse than the noninfected controls (SF12-PCS [34.0 vs. 38.3, p = 0.03]; HHS [76.6 vs. 91.7, p<0.001]; and WOMAC [67.3 vs. 79.3, p = 0.005]). There were no significant differences between the noninfected cohort and the successful IDHPE. Significant differences were found between failed IDHPE and noninfected controls (SF12-PCS [42.5 vs. 34.0, p = 0.011]; HHS [92.3 vs. 79.6, p = 0.004]). There was only difference in SF12-MCS scores (50.3 vs. 57.3, p = 0.012) between the 2SR and failed IDHPE cohorts.
  
  
  CONCLUSIONS
  Patients treated with a successful IDHPE had similar outcomes to noninfected patients. Patients that failed IDHPE and went onto 2SR had similar outcomes to those that had a 2SR alone. IDHPE demonstrated a 59% success rate with PROMs equivalent to a noninfected cohort and should be considered in the treatment algorithm of infected THA.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Western University, London Health Sciences Centre, London - Canada.
authors.forename: Benjamin V
authors.initials: BV
authors.lastname: Herman
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Western University, London Health Sciences Centre, London - Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Nyland
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Western University, London Health Sciences Centre, London - Canada.
authors.forename: Lyndsay
authors.initials: L
authors.lastname: Somerville
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Western University, London Health Sciences Centre, London - Canada.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: MacDonald
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Western University, London Health Sciences Centre, London - Canada.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Lanting
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Western University, London Health Sciences Centre, London - Canada.
authors.forename: James L
authors.initials: JL
authors.lastname: Howard
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007592:Joint Diseases; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D000071066:Patient Reported Outcome Measures; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome