J Korean Orthop Assoc.  2014 Oct;49(5):355-365. 10.4055/jkoa.2014.49.5.355.

Long-Term Clinical Outcome of Two Stage Revision Surgery for Infected Hip Arthroplasty Using Cement Spacer

• Kang JS
• Moon KH
• Lee TJ
• Kim YT
• Ryu DJ
• Choi JH

• KMID: 2185171
• DOI: http://doi.org/10.4055/jkoa.2014.49.5.355

Abstract

PURPOSE
We retrospectively analyzed long-term clinical results after two-stage revision arthroplasty using an antibiotic-impregnated cement spacer for infected total hip arthroplasty.
MATERIALS AND METHODS
Twenty-six hips (group 1: cup exchanged, group 2: cup and stem exchanged) were enrolled in this study. The mean follow-up period was 7.4 years (5 to 11 years). We analyzed the laboratory findings, the time interval between antibiotic-impregnated cement spacer insertion and revision arthroplasty, Harris hip score, Oxford hip score, radiologic changes, and recurrence of infection.
RESULTS
Revision hip arthroplasty was performed at 7.5 weeks on average (group 1: 7.2 weeks, group 2: 7.7 weeks) after implant removal and cement spacer insertion. In group 1, Harris hip score was 51.1 points preoperatively, 84.4 points at six months, 89.3 points in at one year, 91.8 points at three years, and 89.8 points at five years. In group 2, the Harris hip score was 49.8 points preoperatively, 78.1 points at six months, 83.7 points at one year, 90.3 points at three years, and 88.7 points at five years. Recurrence of infection developed in one hip in each group.
CONCLUSION
Ninety-two percent of infected hips were eradicated with two-stage revision arthroplasty using an antibiotic-impregnated cement spacer for infected hip arthroplasty at minimum five-year follow-up. When the infection was limited to the hip joint and the stem was fixed well, two-stage revision with stem retained could be a good treatment option.

Keyword

hip arthroplasty; infection; revision; spacer

MeSH Terms

Arthroplasty*
Arthroplasty, Replacement, Hip
Follow-Up Studies
Hip Joint
Hip*
Recurrence
Retrospective Studies

Figure

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  Figure 1 Management protocol of 1st stage operation: implant removal and prosthesis of antibiotic loaded acrylic cement (PROSTALAC) insertion.

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  Figure 2 Second stage revision arthroplasty, using the stem retention method. (A) Initial radiograph at infection diagnosis. (B) 1st stage operation: acetabular cup removal and prosthesis of antibiotic loaded acrylic cement (PROSTALAC) insertion, stem retention. (C) 2nd stage revision operation after eight weeks. (D, E) There is no definite abnormal finding at one-year, five-year follow-up.

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  Figure 3 Second stage revision arthroplasty, with stem removal. (A) Initial radiograph at infection diagnosis. (B) 1st stage operation: acetabular cup and femoral stem removal and prosthesis of antibiotic loaded acrylic cement (PROSTALAC) insertion. (C) 2nd stage revision operation after seven weeks. (D, E) There is no definite abnormal finding at one-year, five-year follow-up.

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  Figure 4 Laboratory results of 2nd stage revision arthroplasty. (A) Serial change of ESR. (B) Serial change of CRP. PROSTALAC, prosthesis of antibiotic loaded acrylic cement; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein.

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  Figure 5 Clinical results of 2nd stage revision arthroplasty. (A) Serial change of Harris hip score. (B) Serial change of Oxford hip score.

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  Figure 6 Serial change of hip range of motion. (A) Hip flexion with knee flexion. (B) Hip abduction. (C) Hip adduction. (D) Hip external rotation. (E) Hip internal rotation.

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  Figure 7 Second stage revision arthroplasty, with stem removal. (A) Initial radiograph at infection diagnosis. (B) 1st stage operation: acetabular cup and femoral stem removal and prosthesis of antibiotic loaded acrylic cement (PROSTALAC) insertion. (C) Three weeks after 1st stage operation, there is a femur shaft fracture at the distal end of the PROSTALAC stem. (D) 2nd stage revision operation was performed with plate and screw fixation at the femur shaft area. (E) There is no definite abnormal finding at five-year follow-up.

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