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International Orthopaedics

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01-12-2017 | Original Paper

Partial component-retained two-stage reconstruction for chronic infection after uncemented total hip arthroplasty: results of sixteen cases after five years of follow-up

Authors: Kun-Hui Chen, Shang-Wen Tsai, Po-Kuei Wu, Cheng-Fong Chen, Hsin-Yi Wang, Wei-Ming Chen

Published in: International Orthopaedics | Issue 12/2017

Abstract

Purpose

Two-stage reconstruction with total implant removal and re-implantation after infection control is considered the gold standard treatment for infection after hip arthroplasty. However, removal of the well-fixed stem or cup may cause substantial bone loss and other complications, thereby making reconstruction difficult. We evaluated whether an infection post total hip arthroplasty can be treated without removal of the radiographically and clinically well-fixed femoral stem or acetabular cup.

Methods

Patients with a chronic infection after total hip arthroplasty, with a radiographically well-fixed, cementless stem or cup, were selected. During the first surgical stage, we retained the stem or cup if we were unable to remove these with a stem or cup extractor. An antibiotic-impregnated cement spacer was then implanted. After control of infection (C-reactive protein level within normal value), we performed the second stage of re-implantation surgery. Treatment failure was defined as uncontrolled infection requiring removal of the retained implant.

Results

From January 2004 to December 2013, 16 patients underwent partial component-retained two stage reconstruction. Thirteen patients (81.3%) were free of infection, with a mean follow-up time of five years. The remaining three patients, who had high-risk comorbidities and, of whom, two were infected by high-virulence organisms, had uncontrolled infection and required further surgery to remove the retained implant.

Conclusions

Partial component-retained two-stage reconstruction could be an alternative treatment option for chronic infection after an uncemented total hip arthroplasty with a radiographically and clinically well-fixed component in selected patients, who are not immunocompromised and are infected by a low-virulence organism.

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Title: Partial component-retained two-stage reconstruction for chronic infection after uncemented total hip arthroplasty: results of sixteen cases after five years of follow-up
Authors: Kun-Hui Chen
Shang-Wen Tsai
Po-Kuei Wu
Cheng-Fong Chen
Hsin-Yi Wang
Wei-Ming Chen
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 12/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3505-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Partial component-retained two-stage reconstruction for chronic infection after uncemented total hip arthroplasty: results of sixteen cases after five years of follow-up

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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