Two-Stage Revision Arthroplasty for Periprosthetic Hip Infection: Mean Follow-Up of Ten Years

Background. Two-stage revision hip arthroplasty is the gold standard for treatment of patients with chronic periprosthetic joint infection (PJI), but few studies have reported outcomes beyond short-term follow-up.Methods. A total of 155 patients who underwent two-stage revision arthroplasty for chronic PJI in 157 hips were retrospectively enrolled in this study between January 2001 and December 2010. The mean patient age was 57.5 years, the mean prosthetic age was 3.6 years, and the interim interval was 17.8 weeks. These patients were followed up for an average of 9.7 years.Results. At the latest follow-up, 91.7% of the patients were free of infection. The mean Harris hip score improved significantly from 28.3 points before operation to 85.7 points at the latest follow-up. Radiographically, there was aseptic loosening of the stem or acetabular components in 4 patients. In the multivariate survival analysis using a Cox regression model, repeated debridement before final reconstruction, an inadequate interim period, bacteriuria or pyuria, and cirrhosis were found to be the independent risk factors for treatment failure.Conclusion. Our data show that two-stage revision hip arthroplasty provides reliable eradication of infection and durable reconstruction of the joint in patients with PJI caused by a variety of pathogens.

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Two-stage revision arthroplasty in the treatment of periprosthetic hip infections with severe bone loss: Results from 182 cases

Orthopedic Reviews ◽

10.4081/or.2020.8545 ◽

2020 ◽

Vol 12 (2) ◽

Author(s):

Jerzy Białecki ◽

Maciej Kogut ◽

Sławomir Chaberek ◽

Paweł Bartosz ◽

Marcin Obrębski ◽

...

Keyword(s):

Bone Loss ◽

Joint Infection ◽

Revision Arthroplasty ◽

Bone Defects ◽

Harris Hip Score ◽

Two Stage ◽

Retrospective Assessment ◽

Severe Bone Loss ◽

Paprosky Classification

The optimum treatment for periprosthetic joint infection (PJI) of the hip with substantial bone defects remains controversial. A retrospective assessment was performed for 182 patients treated for PJI with a two-stage protocol from 2005 to 2015. Implant removal and debridement were followed by Girdlestone arthroplasty or spacer implantation. The results of the Girdlestone and spacer groups were compared. There were 71 cases that received spacers, and 111 Girdlestone procedures were performed. After the first stage, 26.37% of cultures were negative, and among patients with a detected pathogen, methicillin-sensitive Staphylococcus aureus was the most common organism (41.79%). Acetabular and femoral bone defects, according to the Paprosky classification, were more severe in the Girdlestone group (P<0.05). During the follow-up (mean, 5.95 years), the overall incidence of complications was 21.42%. The mean Harris hip score was significantly lower in the Girdlestone group (68.39 vs 77.79; P<0.0001). The infection recurrence rate reached 8.79%. Despite satisfactory infection control, the number of complications and poor functional outcomes associated with resection arthroplasty indicate the necessity for development of different approaches for patients with advanced bone loss.

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Clinical outcomes and survival rate of cementless modular distal fixation femoral stem for revision hip arthroplasty: A minimum 6-year follow-up

Journal of Orthopaedic Surgery ◽

10.1177/2309499018812241 ◽

2018 ◽

Vol 26 (3) ◽

pp. 230949901881224 ◽

Cited By ~ 1

Author(s):

Joon Soon Kang ◽

Yeop Na ◽

Bong Seong Ko ◽

Yoon Sang Jeon

Keyword(s):

Survival Rate ◽

Hip Arthroplasty ◽

Periprosthetic Fracture ◽

Femoral Stem ◽

Revision Hip Arthroplasty ◽

Harris Hip Score ◽

The Mean ◽

Distal Fixation

Purpose: Revision hip arthroplasty is a very challenging procedure. Use of a modular distal fixation stem is one of the available options for revision arthroplasty in patients with proximal femoral bone deficiency. The purpose of this study was to evaluate mid- to long-term outcomes of cementless modular distal fixation femoral stem implantation in revision hip surgery. Methods: Clinical and radiological findings, complications, and stem survival rate were analyzed for 46 patients (48 hips) who underwent revision hip arthroplasty using a cementless modular distal fixation femoral stem. The mean patient age was 58.8 years (range 31–82 years) and the mean follow-up period was 95 months (72–122 months). The preoperative diagnoses were aseptic loosening (36 hips), infection (4 hips), ceramic fracture (4 hips), and femoral periprosthetic fracture (4 hips). Results: The mean Harris hip score improved from 56.6 preoperatively to 88.2 postoperatively at the last follow-up. All hips showed stable osteointegration and firm fixation. Complications involved four hips (8.3%); there was one case each of periprosthetic fracture, delayed union of osteotomy site, femoral perforation, and infection. One stem re-revision was performed for deep infection of the femoral side. The Kaplan–Meier survival rate was 97.6% at the final follow-up. Conclusion: Revision hip arthroplasty using a cementless modular distal fixation femoral stem showed satisfactory initial firm fixation and mid- to long-term survival rate. Complications can be minimized by careful surgical planning and meticulous procedure.

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Management of the Infected Hip Arthroplasty by Two-Stage Reimplantation

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2019.17 ◽

2003 ◽

Vol 46 (3) ◽

pp. 113-115 ◽

Cited By ~ 8

Author(s):

Karel Karpaš ◽

Pavel Šponer

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Two Stage ◽

Total Hip ◽

Female Patients ◽

One Stage ◽

The Mean ◽

Two Stages

The aim of this study is to present our experience with two-stage reimplantation in the management of the infected hip arthroplasty. Between January 1993 and December 2001 the replacement of the total hip arthroplasty in two stages was performed in 18 patients. There were 7 male and 11 female patients and the average age was 62 years. The mean follow-up after revision was 3.5 years. The mean postoperative Harris Hip Score averaged 78 (50–96) points. None of 18 patients had a recurrence of the infection. Two-stage reconstruction of the infected hip is preferred to one-stage exchange arthroplasty at our department because of higher rate of eradication of the infection.

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Extensively hydroxyapatite-coated long femoral stem revision hip arthroplasty: Clinical outcome and survivorship in 11 to 17.5 years follow up

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720985119 ◽

2021 ◽

pp. 221049172098511

Author(s):

Liu Wing Hong ◽

Chung Kwong Yin ◽

Cheung Kin Wing ◽

Chiu Kwok Hing ◽

Ho Ki Wai Kevin

Keyword(s):

Survival Rate ◽

Clinical Outcome ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Revision Hip Arthroplasty ◽

Harris Hip Score ◽

High Survival ◽

Stem Revision ◽

The Mean

Extensively coated long femoral stem revision hip arthroplasty is based on the principle of distal fixation at diaphyseal region, which can overcome the problem of proximal femoral bone stock deficiencies causing inadequate support and unstable fixation when using conventional length femoral stem. We performed a retrospective cohort analysis of 43 cases of revision hip arthroplasties using extensively hydroxyapatite-coated long femoral stem performed in our department from Jan 1998 to Dec 2005. Patients’ background demographic data, operative details and clinical outcome were analyzed. The mean age at revision surgery was 63.7 (32–84). The mean follow-up period was of 13.8 years (11–17.5 years). In the latest follow up, all patients reported either no or mild hip or thigh pain. 29.2% of patients were able to walk unaided, 25.0% were able to walk with stick, and 33.3% were able to walk with quadripod. The average Harris hip score measured in the latest follow up was 78.8 (55–100). 4.7% were complicated with implant loosening requiring re-revision and 4.7% were complicated with implant infection requiring implant removal. The survival rate was 89.9% at 17.5 years. The femoral stem without femoral fixation augmentation had better survivorship as compared with those with augmentation (p = 0.038). Extensively hydroxyapatite-coated long femoral stem is a good option for revision hip arthroplasty with good clinical outcome and high survival rate.

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Partial two-stage exchange: an alternative method for infected total hip arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04550-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Mumingjiang Yishake ◽

Lan Tang ◽

Xi Chen ◽

Yuejian Wang ◽

Rongxin He

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcomes ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Severe Trauma ◽

Harris Hip Score ◽

Two Stage ◽

Total Hip ◽

The Mean

Abstract Background Total two-stage exchange is commonly used in clinical practice as a treatment for infected total hip arthroplasty (THA); however, this approach involves considerable limitations, including significant bone loss and severe trauma. This retrospective cohort study was conducted to evaluate clinical outcomes following the use of partial two-stage exchange (PTE) for infected THA. Methods We performed a retrospective analysis of 28 patients with infected THA who were treated by PTE between September 2000 and June 2019. Eligibility for PTE was limited to patients with a well-fixed femoral stem prosthesis. In the first stage of the operation, the femoral stem prosthesis was preserved; subsequently, the acetabular prosthesis, liner, and head were replaced with an antibiotic-loaded spacer. The new prosthesis was then implanted into patients and monitored for at least 3 months to ensure freedom from infection. Results Patients were followed for an average of 4 years (range, 2–11 years), with an overall success rate of 85.7% (24/28). The mean Harris hip score at the final follow-up was 76.2 ± 11.7 points. Conclusions The findings of this study suggest that PTE could be an acceptable option for a subset of patients with infected THA, offering a satisfactory infection control rate and clinical outcomes comparable to those of total two-stage exchange, but with less harm.

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Cementless total hip arthroplasty in young patients under the age of 30: a minimum 10-year follow-up

Hip International ◽

10.1177/1120700017752339 ◽

2018 ◽

Vol 28 (5) ◽

pp. 507-513 ◽

Cited By ~ 4

Author(s):

Eun Ho Shin ◽

Kyoung Ho Moon

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Young Patients ◽

Revision Arthroplasty ◽

Activity Level ◽

Head Size ◽

Harris Hip Score ◽

Total Hip ◽

The Mean

Purpose: The purpose of this study was to evaluate the clinical and radiologic outcomes of young patients (under the age of 30) who received a total hip arthroplasty (THA) and in whom patients had been followed for more than 10 years. Materials and methods: This retrospective study was conducted for 51 hips (44 patients) that had undergone THA. The mean age for the index operation was 25.71 years, and the mean follow-up period was 13.7 years. Clinical outcomes were evaluated by Harris hip score (HHS), activity level, and complications. Radiographic evaluations were assessed according to osteolysis, loosening, and polyethylene wear. Results: The average HHS improved from 67.47 pre-operatively to 97.42 at the final follow-up ( p < 0.001). The activity level changed from 1.92 pre-operatively to 1.33 at the final follow-up ( p < 0.001). Ten cases had undergone revision arthroplasty within the follow-up period, and the overall survival rate was 80.4% at the final follow-up with revision for any reason as the end point. Polyethylene liners were used in all revision cases ( p = 0.003). Patients with modular stem had a higher failure rate than patients with a fully porous coated stem ( p < 0.001). Furthermore, a small diameter head size was associated with a higher risk of revision surgery ( p = 0.003). Complications such as dislocations were found in three hips. Conclusion: Cementless THA yields encouraging clinical and radiological results in young and active patients under the age of 30. However, the bearing surface, type of stem, and head size influenced component durability and revision rate.

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A systematic review of short metaphyseal loading cementless stems in hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b5.bjj-2018-1199.r1 ◽

2019 ◽

Vol 101-B (5) ◽

pp. 502-511 ◽

Cited By ~ 10

Author(s):

S. Lidder ◽

D. J. Epstein ◽

G. Scott

Keyword(s):

Systematic Review ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Ethical Practice ◽

Term Survival ◽

The Mean ◽

Review Reports ◽

Femoral Implants ◽

Hip Arthroplasties

Aims Short-stemmed femoral implants have been used for total hip arthroplasty (THA) in young and active patients to conserve bone, provide physiological loading, and reduce the incidence of thigh pain. Only short- to mid-term results have been presented and there have been concerns regarding component malalignment, incorrect sizing, and subsidence. This systematic review reports clinical and radiological outcomes, complications, revision rates, and implant survival in THA using short-stemmed femoral components. Materials and Methods A literature review was performed using the EMBASE, Medline, and Cochrane databases. Strict inclusion and exclusion criteria were used to identify studies reporting clinical and radiological follow-up for short-stemmed hip arthroplasties. Results A total of 28 studies were eligible for inclusion. This included 5322 hips in 4657 patients with a mean age of 59 years (13 to 94). The mean follow-up was 6.1 years (0.5 to 20). The mean Harris Hip Score improved from 46 (0 to 100) to 92 (39 to 100). The mean Oxford Hip Score improved from 25 (2 to 42.5) to 35 (12.4 to 48). The mean Western Ontario & McMaster Universities Osteoarthritis Index improved from 54 (2 to 95) to 22 (0 to 98). Components were aligned in a neutral coronal alignment in up to 90.9% of cases. A total of 15 studies reported component survivorship, which was 98.6% (92% to 100%) at a mean follow-up of 12.1 years. Conclusion Short-stemmed femoral implants show similar improvement in clinical and radiological outcomes compared with conventional length implants. Only mid-term survivorship, however, is known. An abundance of short components have been developed and used commercially without staged clinical trials. Long-term survival is still unknown for many of these components. There remains tension between innovation and the moral duty to ensure that the introduction of new implants is controlled until safety and patient benefit are demonstrated. Implant innovation and subsequent use should be driven by proven clinical outcomes, rather than market and financial forces, and ethical practice must be ensured. Cite this article: Bone Joint J 2019;101-B:502–511.

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32-mm ceramic-on-ceramic total hip arthroplasty versus 28-mm ceramic bearings: 5- to 15-year follow-up study

Hip International ◽

10.1177/1120700018760971 ◽

2018 ◽

Vol 29 (1) ◽

pp. 65-71 ◽

Cited By ~ 3

Author(s):

Yoshitoshi Higuchi ◽

Taisuke Seki ◽

Yukiharu Hasegawa ◽

Yasuhiko Takegami ◽

Daigo Morita ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Total Hip ◽

Kaplan Meier ◽

Significant Difference ◽

Average Patient ◽

The Mean ◽

Ceramic On Ceramic

Introduction: This study aimed to compare the clinical and radiographic results of 28-mm ceramic-on-ceramic (CoC) total hip arthroplasty (THA) to those of 32-mm CoC during a 5- to 15-year follow-up period. Methods: 107 joints (95 women and 6 men) underwent 28-mm CoC, and 60 (49 women and 7 men) underwent 32-mm CoC. The average patient age at the time of surgery was 56.1 and 55.7 years in the 28-mm and 32-mm CoC groups, respectively. Clinical and radiologic measurements of all patients were analysed. Results: The mean preoperative Harris hip score (HHS) was similar in the 2 groups (28-mm, 58.9; and 32-mm, 58.5). However, at final follow-up, the mean HHS of the 32-mm CoC (91.8) was significantly better than that of the 28-mm CoC (88.2) ( p = 0.003), as were the ranges of motion (ROM) for flexion (98.3 ± 13.5° vs. 87.3 ± 19.3°, p < 0.001) and abduction (27.8 ± 14.9° vs. 22.1 ± 19.3°, p = 0.007). The mean wear rate was 0.0044 mm/year for the 28-mm CoC and 0.0044 mm/year for the 32-mm CoC. No ceramic fractures were found in the 2 groups. One joint in the 28-mm CoC (0.9%) required revision owing to progressive osteolysis. Kaplan-Meier survival at 10 years, with implant loosening or revision THA as the endpoint, was 98.3% for 28-mm CoC and 100% for 32-mm CoC ( p = 0.465). Conclusion: There was no significant difference in ceramic-related complications between the 2 groups. Our study demonstrated that the 32-mm and 28-mm CoC are safe and are associated with good clinical outcomes.

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Outcomes of repeat two-stage exchange hip arthroplasty for prosthetic joint infection

The Bone & Joint Journal ◽

10.1302/0301-620x.101b6.bjj-2018-1556.r1 ◽

2019 ◽

Vol 101-B (6_Supple_B) ◽

pp. 110-115 ◽

Cited By ~ 10

Author(s):

N. Khan ◽

D. Parmar ◽

M. S. Ibrahim ◽

B. Kayani ◽

F. S. Haddad

Keyword(s):

Hip Arthroplasty ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Antimicrobial Treatment ◽

Successful Outcome ◽

Two Stage ◽

Persistent Symptoms ◽

Prosthetic Joint ◽

Revision Tha

Aims The increasing infection burden after total hip arthroplasty (THA) has seen a rise in the use of two-stage exchange arthroplasty and the use of increasingly powerful antibiotics at the time of this procedure. As a result, there has been an increase in the number of failed two-stage revisions during the past decade. The aim of this study was to clarify the outcome of repeat two-stage revision THA following a failed two-stage exchange due to recurrent prosthetic joint infection (PJI). Patients and Methods We identified 42 patients who underwent a two-stage revision THA having already undergone at least one previous two stage procedure for infection, between 2000 and 2015. There were 23 women and 19 men. Their mean age was 69.3 years (48 to 81). The outcome was analyzed at a minimum follow-up of two years. Results A satisfactory control of infection and successful outcome was seen in 26 patients (57%). There therefore remained persistent symptoms that either required further surgery or chronic antibiotic suppression in 16 patients (38%). One-third of patients had died by the time of two years’ follow-up. Conclusion The rate of failure and complication rate of repeat two-stage exchange THA for PJI is high and new methods of treatment including host optimization, immunomodulation, longer periods between stages, and new and more powerful forms of antimicrobial treatment should be investigated. Cite this article: Bone Joint J 2019;101-B(6 Supple B):110–115.

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