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: 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.