Mid-term outcomes of a partial 2-stage approach in late chronic periprosthetic hip infections

Francesco Castagnini, Giuseppe Tella, Maurizio Montalti, Federico Biondi, Barbara Bordini, Luca Busanelli, Aldo Toni

Research output: Contribution to journalArticle

Abstract

Introduction: Late chronic periprosthetic infections (LCPIs) are worrisome complications of primary hip arthroplasties. The gold standard procedure is the 2-stage revision. 1-stage exchange is gaining popularity in order to reduce the invasivity of the former technique. A partial 2-stage exchange technique, retaining fixed components, may overcome some of the drawbacks of the previous techniques, allowing a much easier reconstruction step. Methods: 28 patients with a LCPI after a primary total hip arthroplasty underwent a first removal stage: the loosened component was removed (23 cups and 5 stems) and the fixed component, with no local signs of infection, was retained. An antibiotic hand molded spacer was positioned in 16 cases. After a mean time of 8 months and a tailored antimicrobial therapy, the spacer was removed and the implant was revised. Results: The mean follow-up was 5 years. The HHS score was 82.7. 4 cases failed (2 patients presenting a septic relapse after revision and 2 patients undergoing Girdlestone arthroplasty, achieving a survival rate of 83.4% at 5 years. 2 patients were unwilling to perform a further procedure and did not proceed to the second stage. All the other patients had no clinical, radiological, laboratory signs of septic relapse. Conclusions: The partial 2-stage approach seems a promising technique for LCPI in selected cases, with good infection control. It allows an easier revision by sparing the fixed components. Larger case series and longer follow-ups are needed to confirm the results and identify the limits of this approach.

Original languageEnglish
JournalHIP International
DOIs
Publication statusAccepted/In press - Jan 1 2020

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Hip
Arthroplasty
Infection
Recurrence
Infection Control
Survival Rate
Hand
Anti-Bacterial Agents
Therapeutics

Keywords

  • Fixed
  • osseointegration
  • partial 2 stage
  • periprosthetic hip infection
  • retention
  • spacer

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Mid-term outcomes of a partial 2-stage approach in late chronic periprosthetic hip infections. / Castagnini, Francesco; Tella, Giuseppe; Montalti, Maurizio; Biondi, Federico; Bordini, Barbara; Busanelli, Luca; Toni, Aldo.

In: HIP International, 01.01.2020.

Research output: Contribution to journalArticle

Castagnini, Francesco ; Tella, Giuseppe ; Montalti, Maurizio ; Biondi, Federico ; Bordini, Barbara ; Busanelli, Luca ; Toni, Aldo. / Mid-term outcomes of a partial 2-stage approach in late chronic periprosthetic hip infections. In: HIP International. 2020.
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