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Is two-stage revision surgery for infected hip arthroplasty worth the suffering, resources and results compared to one-stage?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2022 (English)In: HIP International, ISSN 1120-7000, E-ISSN 1724-6067, Vol. 32, no 2, p. 205-212, article id 1120700020949162Article in journal (Refereed) Published
Abstract [en]

Purpose: Periprosthetic joint infection (PJI) is the most serious complication of total hip arthroplasty. The treatment is usually revision in either 1 or 2 stages. This study analyses revision with impaction bone grafting for periprosthetic joint infection of the hip and compares 1- and 2-stage strategies. Patients and methods: We reviewed 55 consecutive cases (54 patients) of revision arthroplasty for PJI carried out at our hospital between 2002 and 2016. Of these, 46 were 2-stage procedures. 21 had vancomycin mixed in with the bone graft, and all had gentamycin-containing bone cement. The total perioperative blood loss, duration of operation, and length of hospital stay were recorded. Clinical and radiological results were analysed for 48 hips at 2-16 years follow-up. Results: No PJI remained at follow-up. 3 patients (6%) had undergone revision for all causes. 1 had radiological signs of mechanical loosening but was not revised. 2-stage procedures had a significantly longer operating time (409 vs. 238 min) and hospital stay (34 vs. 13 days), greater blood loss (2764 vs. 1638 ml), and lower mean functional hip score (15.9 vs. 17.5) at follow-up than the one-stage procedures. Interpretation: Revision total hip arthroplasty for PJI with vancomycin-loaded impaction bone grafting is a safe method that achieves both the restoration of bone stock and resolution of the infection. This single-stage procedure could therefore be the new gold standard for treatment of non-complicated PJI in the hip.

Place, publisher, year, edition, pages
Uppsala Univ, Dept Orthopaed, Cty Council Gavleborg, Gavle Hosp, Gavle, Sweden. Uppsala Univ, Ctr Res & Dev, Cty Council Gavleborg, Gavle, Sweden.: SAGE Publications Sage Publications, 2022. Vol. 32, no 2, p. 205-212, article id 1120700020949162
Keywords [en]
Antibiotic carrier, periprosthetic joint infection, revision, total hip arthroplasty
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-477816DOI: 10.1177/1120700020949162ISI: 000559618500001PubMedID: 32777947OAI: oai:DiVA.org:uu-477816DiVA, id: diva2:1673730
Available from: 2022-06-21 Created: 2022-06-21 Last updated: 2024-12-03Bibliographically approved

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Sotiriou, DimitriosStigbrand, HampusUllmark, Gösta

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