Two-stage revision of infected hip arthroplasty
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Published:
Jun 30, 2014
Keywords:
Infected hip arthroplasty. Revision. Two-stages. Antibiotics. Spacer
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Abstract
Background: infection of a total hip arthroplasty is one of the most serious complications, and the revision can be accomplished in one or two surgical stages. The aim of this study was to evaluate a prospective series of patients with infected total hip arthroplasty with a two-stage revision. Methods: We evaluated 72 two-stage revisions of infected total hip arthroplasty (subacute and chronic), in 71 patients, with an average follow-up of 6.4 years (1 to 12 years). A cement spacer with antibiotics was used in all cases.Results: Infection resolved in 96% of cases (69 hips). We used 59 spacers which were “hand-made” in the operating room (82%) and 13 prefabricated ones. The most common pathogen was coagulase-negative Staphylococcus (23 cases). There were 8 complications: 4 spacer dislocations, 2 peri-spacer fractures and 2 spacer fractures.Conclusion: Two-stage revisions show excellent cure rates of infection. Success depends on an extensive surgical debridement, on the use of a spacer with the appropriate antibiotic and on a customized postoperative antibiotic protocol.
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Vedoya, S. P., Garabano, G., Nazur, G., Gómez, G., Martinez, J., & Del Sel, H. (2014). Two-stage revision of infected hip arthroplasty. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 79(2), 117-123. https://doi.org/10.15417/319
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Clinical Research
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References
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clinical and radiological outcome. Arch Orthop Traum Surg 2007;127:691-7.
2. Karrholm J, Garellick G, Herberts P. Annual Report 2006, Swedish Hip Arthroplasty Register.
3. McKenna PB, Oshea K, Masterson EL. Two stage revision of infected hip arthroplasty using a shortened post-operative course
of antibiotics. Arch Orthop Traum Surg 2009;129:489-94.
4. Zimmerli W. Prosthetic-joint-associated infections. Best Pract Res Clin Rheumatol 2006;20(6):1045-63.
5. Davis CM, Berry DJ, Harmsen WS. Cemented revision of failed uncemented femoral components of total hip arthroplasty. J
Bone Joint Surg Am 2003;85:1264-9.
6. Marotte JH, Blanchard JP, Servant JP. Infection rate in total hip arthroplasty as a function of air cleanliness and antibiotic
prophylaxis. J Arthroplasty 1987;2:77-82.
7. Schutzer SF, Harris WH. Deep wound infection after total hip replacement under contemporary aseptic conditions. J Bone Joint
Surg Am 1988;70:724-7.
8. Garvin KL, Hanssen AD. Current concepts review: infection after total hip arthroplasty. J Bone Joint Surg Am 1998;77:1576-88.
9. Garvin KL, Evans BG, Salvati EA. Palacos gentamicin for the treatment of deep periprosthetic hip infections. Clin Orthop
Relat Res 1994;298:97-105.
10. Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. J Bone Joint Surg Am
1998;80:910-22.
11. Kraay JM, Goldberg VM, Fitzgerald SJ. Cementless two stage total hip arthroplasty for deep periphrosthetic infection. Clin
Orthop Relat Res 2005;441:243-9.
12. Lieberman JR, Salvati EA. Treatment of infected total hip arthroplasty with two stage reimplantation protocol. Clin Orthop
Relat Res 1994;301:205-12.
13. Duncan CP, Masri BA. The role of antibiotic loaded bone cement in the treatment of an infection after a hip replacement. J Bone
Joint Surg Am 1994;76:1742-51.
14. Sanchez-Sotelo J, Berry D, Hanssen AD. Midterm to long-term follow up of staged reimplantation for infected hip arthroplasty.
Clin Orthop Relat Res 2009;467:219-24.
15. Bring GS, Masri BA, Duncan CP. Two stage revision arthroplasty of the hip for infection using an interim articulated Prostalac
hip spacer. J Bone Joint Surg Br 2009;91:1431-7.
16. McDonald DJ, Fitzgerald RH. Two stage reconstruction of total hip arthroplasty because of infection. J Bone Joint Surg Am
1989;71:828-34.
17. Buchholz HW, Elson RA, Engelbrech E. Management of deep infection of total hip replacement. J Bone Joint Surg Br
1981;63:342-52.
18. Raut VV, Siney PD, Wrobleski BM. One stage revision of total hip arthroplasty for deep infection. Clin Orthop 1995;321:202-
7.
19. Murray WR. Use of antibiotic containing bone cement. Clin Orthop 1984;190:90.
20. Autorino CM, Rivarola EF, Parizzia WM, Galli SM, Raimondi N, Codesido M. Megaespaciadores y espaciadores modulares
confeccionados a medida. Rev Asoc Argent Ortop Traumatol 2011;76(1):20-9.
21. Schatcher S, Castoldi P, Otaño Sahores A. Reemplazo total de cadera infectado. Rev Asoc Argent Ortop Traumatol
1991;56(2):212-22.
22. Fitzgerald Jury RH. Infected total hip arthroplasty: diagnosis and treatment. J Am Acad Orthop Surg 1995;3:249-62.
23. Haddad FS, Muirhead SK, Manktelow ARJ. Two stage uncemented revision hip arthroplasty for infection. J Bone Joint Surg
Br 2000;82:689-94.
24. Hsieh Pang-Hsin, Kuo- Chin H, Ching-Lung T. Liquid gentamicin in bone cement spacer: in vivo antibiotic release and
systemic safety in two-stage revision of infected hip arthroplasty. J Trauma 2009;66(3):804-8.
25. Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. J Bone Joint Surg Am 1996;78:512-23.
26. English H, Timperley A, Dunlop EGG. Impaction grafting of the femur in two stage revision for infected total hip replacement.
J Bone Joint Surg Br 2002;84:700-5.
27. Stockley I, Mockford BJ, Hoad-Reddick A. The use of two stage exchange arthroplasty with depot antibiotic en the absence of
long term antibiotic therapy in infected total hip replacement. J Bone Joint Surg Br 2008;90:1580-4.
28. Kadurugamuwa JL, Sin LV, Yu J. Noninvasive optical imaging to evaluate postantibiotic effects on biofilm infection in vivo.
Antimicrob Agents Chemother 2004;48:2283-7.
clinical and radiological outcome. Arch Orthop Traum Surg 2007;127:691-7.
2. Karrholm J, Garellick G, Herberts P. Annual Report 2006, Swedish Hip Arthroplasty Register.
3. McKenna PB, Oshea K, Masterson EL. Two stage revision of infected hip arthroplasty using a shortened post-operative course
of antibiotics. Arch Orthop Traum Surg 2009;129:489-94.
4. Zimmerli W. Prosthetic-joint-associated infections. Best Pract Res Clin Rheumatol 2006;20(6):1045-63.
5. Davis CM, Berry DJ, Harmsen WS. Cemented revision of failed uncemented femoral components of total hip arthroplasty. J
Bone Joint Surg Am 2003;85:1264-9.
6. Marotte JH, Blanchard JP, Servant JP. Infection rate in total hip arthroplasty as a function of air cleanliness and antibiotic
prophylaxis. J Arthroplasty 1987;2:77-82.
7. Schutzer SF, Harris WH. Deep wound infection after total hip replacement under contemporary aseptic conditions. J Bone Joint
Surg Am 1988;70:724-7.
8. Garvin KL, Hanssen AD. Current concepts review: infection after total hip arthroplasty. J Bone Joint Surg Am 1998;77:1576-88.
9. Garvin KL, Evans BG, Salvati EA. Palacos gentamicin for the treatment of deep periprosthetic hip infections. Clin Orthop
Relat Res 1994;298:97-105.
10. Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. J Bone Joint Surg Am
1998;80:910-22.
11. Kraay JM, Goldberg VM, Fitzgerald SJ. Cementless two stage total hip arthroplasty for deep periphrosthetic infection. Clin
Orthop Relat Res 2005;441:243-9.
12. Lieberman JR, Salvati EA. Treatment of infected total hip arthroplasty with two stage reimplantation protocol. Clin Orthop
Relat Res 1994;301:205-12.
13. Duncan CP, Masri BA. The role of antibiotic loaded bone cement in the treatment of an infection after a hip replacement. J Bone
Joint Surg Am 1994;76:1742-51.
14. Sanchez-Sotelo J, Berry D, Hanssen AD. Midterm to long-term follow up of staged reimplantation for infected hip arthroplasty.
Clin Orthop Relat Res 2009;467:219-24.
15. Bring GS, Masri BA, Duncan CP. Two stage revision arthroplasty of the hip for infection using an interim articulated Prostalac
hip spacer. J Bone Joint Surg Br 2009;91:1431-7.
16. McDonald DJ, Fitzgerald RH. Two stage reconstruction of total hip arthroplasty because of infection. J Bone Joint Surg Am
1989;71:828-34.
17. Buchholz HW, Elson RA, Engelbrech E. Management of deep infection of total hip replacement. J Bone Joint Surg Br
1981;63:342-52.
18. Raut VV, Siney PD, Wrobleski BM. One stage revision of total hip arthroplasty for deep infection. Clin Orthop 1995;321:202-
7.
19. Murray WR. Use of antibiotic containing bone cement. Clin Orthop 1984;190:90.
20. Autorino CM, Rivarola EF, Parizzia WM, Galli SM, Raimondi N, Codesido M. Megaespaciadores y espaciadores modulares
confeccionados a medida. Rev Asoc Argent Ortop Traumatol 2011;76(1):20-9.
21. Schatcher S, Castoldi P, Otaño Sahores A. Reemplazo total de cadera infectado. Rev Asoc Argent Ortop Traumatol
1991;56(2):212-22.
22. Fitzgerald Jury RH. Infected total hip arthroplasty: diagnosis and treatment. J Am Acad Orthop Surg 1995;3:249-62.
23. Haddad FS, Muirhead SK, Manktelow ARJ. Two stage uncemented revision hip arthroplasty for infection. J Bone Joint Surg
Br 2000;82:689-94.
24. Hsieh Pang-Hsin, Kuo- Chin H, Ching-Lung T. Liquid gentamicin in bone cement spacer: in vivo antibiotic release and
systemic safety in two-stage revision of infected hip arthroplasty. J Trauma 2009;66(3):804-8.
25. Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. J Bone Joint Surg Am 1996;78:512-23.
26. English H, Timperley A, Dunlop EGG. Impaction grafting of the femur in two stage revision for infected total hip replacement.
J Bone Joint Surg Br 2002;84:700-5.
27. Stockley I, Mockford BJ, Hoad-Reddick A. The use of two stage exchange arthroplasty with depot antibiotic en the absence of
long term antibiotic therapy in infected total hip replacement. J Bone Joint Surg Br 2008;90:1580-4.
28. Kadurugamuwa JL, Sin LV, Yu J. Noninvasive optical imaging to evaluate postantibiotic effects on biofilm infection in vivo.
Antimicrob Agents Chemother 2004;48:2283-7.