Preservation of Fixed Cementless Femoral Stems in Patients with Chronic Periprosthetic Hip Infection
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Published:
Oct 17, 2023
Keywords:
Partial review, chronic periprosthetic infection
Main Article Content
Abstract
Introduction: Two-stage revision is considered the gold standard for the treatment of chronically infected hip arthroplasty. However, during the removal of a fixed cementless femoral stem, the proximal femur can be damaged, which can lead to difficulties in reimplantation.
Objective: We intend to determine if chronic periprosthetic hip infection can be treated with a partial exchange of its components, in two stages, keeping a fixed cementless femoral stem.
Materials and Methods: This retrospective, multicenter case series study included 9 patients with chronic infection following hip arthroplasty, scheduled for single- or two-stage partial exchange with retention of the fixed femoral stem between January 2014 and November 2019. We assessed the patients’ progress through clinical examination, Harris Hip Score evaluation, and laboratory and radiological studies.
Results: In a mean follow-up of 5.8 years in 9 patients with cementless hip arthroplasty, 8 patients achieved infection remission (88.9%) after prosthetic reimplantation, and the mean Harris Hip Score reached 81 points at the last follow-up evaluation. There was no loosening of acetabular or femoral components.
Conclusions: Uncemented femoral stem retention may represent an acceptable option for patients withchronic periprosthetic hip infection when removal of the femoral component would result in significant bone loss and compromise of the reconstruction. However, more studies are required on this treatment.
Objective: We intend to determine if chronic periprosthetic hip infection can be treated with a partial exchange of its components, in two stages, keeping a fixed cementless femoral stem.
Materials and Methods: This retrospective, multicenter case series study included 9 patients with chronic infection following hip arthroplasty, scheduled for single- or two-stage partial exchange with retention of the fixed femoral stem between January 2014 and November 2019. We assessed the patients’ progress through clinical examination, Harris Hip Score evaluation, and laboratory and radiological studies.
Results: In a mean follow-up of 5.8 years in 9 patients with cementless hip arthroplasty, 8 patients achieved infection remission (88.9%) after prosthetic reimplantation, and the mean Harris Hip Score reached 81 points at the last follow-up evaluation. There was no loosening of acetabular or femoral components.
Conclusions: Uncemented femoral stem retention may represent an acceptable option for patients withchronic periprosthetic hip infection when removal of the femoral component would result in significant bone loss and compromise of the reconstruction. However, more studies are required on this treatment.
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How to Cite
Martínez, W. F., Tillet, F., Bochatey, E. J., & Lopreite, F. A. (2023). Preservation of Fixed Cementless Femoral Stems in Patients with Chronic Periprosthetic Hip Infection. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(5), 539-547. https://doi.org/10.15417/issn.1852-7434.2023.88.5.1777
Section
Clinical Research
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References
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Clin Orthop Relat Res 2011;469(11):3022-30. https://doi.org/10.1007/s11999-011-1971-2
6. Hsieh PH, Shih CH, Chang YH, Lee MS, Yang WE, Shih HN. Treatment of deep infection of the hip associated
with massive bone loss: two-stage revision with an antibiotic-loaded interim cement prosthesis followed by
reconstruction with allograft. J Bone Joint Surg Br 2005;87(6):770-5. https://doi.org/10.1302/0301-620X.87B6.15411
7. Maurer SG, Baitner AC, Di Cesare PE. Reconstruction of the failed femoral component and proximal femoral bone loss in revision hip surgery. J Am Acad Orthop Surg 2000;8(6):354-63. https://doi.org/10.5435/00124635-200011000-00003
8. Younger AS, Duncan CP, Masri BA. Treatment of infection associated with segmental bone loss in the proximal part of the femur in two stages with use of an antibiotic-loaded interval prosthesis. J Bone Joint Surg Am 1998;80(1):60-9. https://doi.org/10.2106/00004623-199801000-00011
9. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004;351(16):1645-54.
https://doi.org/10.1056/NEJMra040181
10. Taylor PR, Stoffel KK, Dunlop DG, Yates PJ. Removal of the well-fixed hip resurfacing acetabular component: a
simple, bone preserving technique. J Arthroplasty 2009;24(3):484-6. https://doi.org/10.1016/j.arth.2008.01.305
11. Preiss RA, Patil S, Meek RM. The use of modular femoral head trials to centre the Explant blade facilitates retrieval of well-fixed acetabular components with minimal bone loss. Arch Orthop Trauma Surg 2011;131(7):1003-6. https://doi.org/10.1016/j.arth.2008.01.305
12. Kaneuji A, Sugimori T, Ichiseki T, Fukui K, Takahashi E, Matsumoto T. Cementless anatomic total hip femoral
component with circumferential porous coating for hips with developmental dysplasia: a minimum ten-year followup period. J Arthroplasty 2013;28(10):1746-50. https://doi.org/10.1016/j.arth.2013.06.030
13. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res
2011;469(11):2992-4. https://doi.org/10.1007/s11999-011-2102-9
14. Parvizi J, Gehrke T, Chen AF. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J 2013;95-B(11):1450-2. https://doi.org/10.1302/0301-620X.95B11.33135
15. Parvizi J, Gehrke T. International consensus on periprosthetic joint infection: let cumulative wisdom be a guide. J Bone Joint Surg Am 2014;96(6):441. https://doi.org/10.2106/JBJS.N.00023
16. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 1976;(121):20-32. PMID: 991504
17. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a
radiographic analysis of loosening. Clin Orthop Relat Res 1979;(141):17-27. PMID: 477100
18. Diaz-Ledezma C, Higuera CA, Parvizi J. Success after treatment of periprosthetic joint infection: A delphi-based international multidisciplinary consensus infection. Clin Orthop Relat Res 2013;471(7):2374-82.
https://doi.org/10.1007/s11999-013-2866-1
19. Struhl S, Harwin SF, Stern RE, Kulick RG. Infected uncemented hip arthroplasty. Preserving the femoral stem with a two-stage revision procedure. Orthop Rev 1989;18(6):707-12. PMID: 2664672
20. Ekpo TE, Berend KR, Morris MJ, Adams JB, Lombardi AV Jr. Partial 2-stage exchange for infected total hip
arthroplasty: An updated report. J Arthroplasty 2019;34(12):3048-53. https://doi.org/10.1016/j.arth.2019.07.001
21. Ji B, Xu B, Guo W. Retention of the well-fixed implant in the single-stage exchange for chronic infected total hip arthroplasty: an average of five years of follow-up. Int Orthop 2017;41(5):901-9. https://doi.org/10.1007/s00264-016-3291-3
22. El-Husseiny M, Haddad F. The role of highly selective implant retention in the infected hip arthroplasty. Clin
Orthop Relat Res 2016;474(10):2157-63. https://doi.org/10.1007/s11999-016-4936-7
23. Fishley W, Selvaratnam V, Whitehouse S, Kassam A. Cement-in-cement revision of the femur in infected hip
arthroplasty in 89 patients across two centres. Bone Joint J 2022;104-B(2):212-20. https://doi.org/10.1302/0301-620X.104B2.BJJ-2021-0598.R1
2. Pagano I. Reporte anual de vigilancia de infecciones asociadas al cuidado de la salud 2021. Administración
Nacional de Laboratorios e Institutos de Salud (ANLIS) Dr. C. Malbrán, Buenos Aires. Disponible en:
http://sgc.anlis.gob.ar/handle/123456789/2436
3. Vila A, Kremer G, Chuluyan J, Querci M, Sanchez M, Paz Sierra M. Diagnóstico de infecciones asociadas a
artroplastias. Medicina (Buenos Aires) 2022;82(2):249-61. PMID: 35417390
4. Della Valle C, Parvizi J, Bauer TW. Dicesare PE, Parker Evans R, Segretiet J, et al. Diagnosis of periprothesic joint
infections of the hip and knee. J Am Acad Orthop Surg 2010;18(12):760-70. https://doi.org/10.5435/00124635-201012000-00006
5. Parvizi J, Jacovides C, Zmistowski B, Jung KA. Definition of periprosthetic joint infection: is there a consensus?
Clin Orthop Relat Res 2011;469(11):3022-30. https://doi.org/10.1007/s11999-011-1971-2
6. Hsieh PH, Shih CH, Chang YH, Lee MS, Yang WE, Shih HN. Treatment of deep infection of the hip associated
with massive bone loss: two-stage revision with an antibiotic-loaded interim cement prosthesis followed by
reconstruction with allograft. J Bone Joint Surg Br 2005;87(6):770-5. https://doi.org/10.1302/0301-620X.87B6.15411
7. Maurer SG, Baitner AC, Di Cesare PE. Reconstruction of the failed femoral component and proximal femoral bone loss in revision hip surgery. J Am Acad Orthop Surg 2000;8(6):354-63. https://doi.org/10.5435/00124635-200011000-00003
8. Younger AS, Duncan CP, Masri BA. Treatment of infection associated with segmental bone loss in the proximal part of the femur in two stages with use of an antibiotic-loaded interval prosthesis. J Bone Joint Surg Am 1998;80(1):60-9. https://doi.org/10.2106/00004623-199801000-00011
9. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004;351(16):1645-54.
https://doi.org/10.1056/NEJMra040181
10. Taylor PR, Stoffel KK, Dunlop DG, Yates PJ. Removal of the well-fixed hip resurfacing acetabular component: a
simple, bone preserving technique. J Arthroplasty 2009;24(3):484-6. https://doi.org/10.1016/j.arth.2008.01.305
11. Preiss RA, Patil S, Meek RM. The use of modular femoral head trials to centre the Explant blade facilitates retrieval of well-fixed acetabular components with minimal bone loss. Arch Orthop Trauma Surg 2011;131(7):1003-6. https://doi.org/10.1016/j.arth.2008.01.305
12. Kaneuji A, Sugimori T, Ichiseki T, Fukui K, Takahashi E, Matsumoto T. Cementless anatomic total hip femoral
component with circumferential porous coating for hips with developmental dysplasia: a minimum ten-year followup period. J Arthroplasty 2013;28(10):1746-50. https://doi.org/10.1016/j.arth.2013.06.030
13. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res
2011;469(11):2992-4. https://doi.org/10.1007/s11999-011-2102-9
14. Parvizi J, Gehrke T, Chen AF. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J 2013;95-B(11):1450-2. https://doi.org/10.1302/0301-620X.95B11.33135
15. Parvizi J, Gehrke T. International consensus on periprosthetic joint infection: let cumulative wisdom be a guide. J Bone Joint Surg Am 2014;96(6):441. https://doi.org/10.2106/JBJS.N.00023
16. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 1976;(121):20-32. PMID: 991504
17. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a
radiographic analysis of loosening. Clin Orthop Relat Res 1979;(141):17-27. PMID: 477100
18. Diaz-Ledezma C, Higuera CA, Parvizi J. Success after treatment of periprosthetic joint infection: A delphi-based international multidisciplinary consensus infection. Clin Orthop Relat Res 2013;471(7):2374-82.
https://doi.org/10.1007/s11999-013-2866-1
19. Struhl S, Harwin SF, Stern RE, Kulick RG. Infected uncemented hip arthroplasty. Preserving the femoral stem with a two-stage revision procedure. Orthop Rev 1989;18(6):707-12. PMID: 2664672
20. Ekpo TE, Berend KR, Morris MJ, Adams JB, Lombardi AV Jr. Partial 2-stage exchange for infected total hip
arthroplasty: An updated report. J Arthroplasty 2019;34(12):3048-53. https://doi.org/10.1016/j.arth.2019.07.001
21. Ji B, Xu B, Guo W. Retention of the well-fixed implant in the single-stage exchange for chronic infected total hip arthroplasty: an average of five years of follow-up. Int Orthop 2017;41(5):901-9. https://doi.org/10.1007/s00264-016-3291-3
22. El-Husseiny M, Haddad F. The role of highly selective implant retention in the infected hip arthroplasty. Clin
Orthop Relat Res 2016;474(10):2157-63. https://doi.org/10.1007/s11999-016-4936-7
23. Fishley W, Selvaratnam V, Whitehouse S, Kassam A. Cement-in-cement revision of the femur in infected hip
arthroplasty in 89 patients across two centres. Bone Joint J 2022;104-B(2):212-20. https://doi.org/10.1302/0301-620X.104B2.BJJ-2021-0598.R1