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

Joon-Soon Kang; Kyoung Ho Moon; Tong-Joo Lee; Young-Tae Kim; Dong-Jin Ryu; Jae-Hwang Choi

doi:10.4055/jkoa.2014.49.5.355

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Kang, Moon, Lee, Kim, Ryu, and Choi: Long-Term Clinical Outcome of Two Stage Revision Surgery for Infected Hip Arthroplasty Using Cement Spacer

Original Article

Journal of the Korean Orthopaedic Association 2014; 49(5): 355-365.

Published online: 30 October 2014

DOI: https://doi.org/10.4055/jkoa.2014.49.5.355

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

Joon-Soon Kang, M.D., Kyoung Ho Moon, M.D., Tong-Joo Lee, M.D., Young-Tae Kim, M.D., Dong-Jin Ryu, M.D., Jae-Hwang Choi, M.D.

Department of Orthopedic Surgery, Inha University School of Medicine, Incheon, Korea.

Correspondence to: Young-Tae Kim, M.D. Department of Orthopedic Surgery, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon 400-711, Korea. TEL: +82-32-890-2800, FAX: +82-32-890-3047, zero-ti@hanmail.net

Received 19 December 2013 Revised 28 February 2014 Accepted 28 June 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: hip arthroplasty, infection, revision, spacer

Figures and Tables

Figure 1

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

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.

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.

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.

Figure 5

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

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.

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.

Table 1

Culture Organism from Infected Hip Arthroplasty

MSSA, methicillin-sensitive Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; CNS, coagulase negative Staphylococcus aureus.

Table 2

Results of 2nd Stage Revision Arthroplasty, according to Stem Management Method

Values are presented as number (%).

References

1. Blom AW, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Infection after total hip arthroplasty. The Avon experience. J Bone Joint Surg Br. 2003; 85:956–959.

2. Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am. 2005; 87:1746–1751.

3. Hunter GA, Welsh RP, Cameron HU, Bailey WH. The results of revision of total hip arthroplasty. J Bone Joint Surg Br. 1979; 61:419–421.

4. Han HJ, You JM. Two stage exchange of infected total hip arthroplasty. J Korean Hip Soc. 1998; 10:127–133.

5. Moon KH, Kang JS, Lee TJ, Jung JH. Two-stage revision surgery of the infected hip bipolar hemiarthroplasty using the PROSTALAC. J Korean Orthop Assoc. 2005; 40:442–448.

6. Park BJ, Cho HM, Sim JH, Choi HJ. Treatment of infected hip arthroplasty with antibiotic-impregnated calcium sulfate cement. J Korean Hip Soc. 2011; 23:310–317.

7. Sung YB, Lee EY, Ahn JK, et al. Antibiotic-loaded cement spacers for two-stage arthroplasties of infected hip joints for two-stage arthroplasties of infected hip joints. J Korean Hip Soc. 2000; 12:18–27.

8. Sung YB, Oh JS. Staged revision of infected hip arthroplasty using an antibiotics-loaded intra-articular cement spacer with retention of the stem. J Korean Hip Soc. 2010; 22:66–72.

9. Lee YK, Lee KH, Nho JH, Ha YC, Koo KH. Retaining well-fixed cementless stem in the treatment of infected hip arthroplasty. Acta Orthop. 2013; 84:260–264.

10. Yang JW, Koo KH, Cho SH, et al. Two-stage arthroplasty for infected total hip arthroplasty utilizing a cement spacer impregnated with triple antibiotics (Vancomycin, Cephalosporin, Gentamicin). J Korean Hip Soc. 1999; 11:86–93.

11. Masri BA, Panagiotopoulos KP, Greidanus NV, Garbuz DS, Duncan CP. Cementless two-stage exchange arthroplasty for infection after total hip arthroplasty. J Arthroplasty. 2007; 22:72–78.

12. White J, Kelly M, Dunsmuir R. C-reactive protein level after total hip and total knee replacement. J Bone Joint Surg Br. 1998; 80:909–911.

13. Hart WJ, Jones RS. Two-stage revision of infected total knee replacements using articulating cement spacers and short-term antibiotic therapy. J Bone Joint Surg Br. 2006; 88:1011–1015.

14. Phillips JE, Crane TP, Noy M, Elliott TS, Grimer RJ. The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg Br. 2006; 88:943–948.

15. Esenwein SA, Robert K, Kollig E, Ambacher T, Kutscha-Lissberg F, Muhr G. Long-term results after resection arthroplasty according to Girdlestone for treatment of persisting infections of the hip joint. Chirurg. 2001; 72:1336–1343.

16. Grauer JD, Amstutz HC, O'Carroll PF, Dorey FJ. Resection arthroplasty of the hip. J Bone Joint Surg Am. 1989; 71:669–678.

17. Buchholz HW, Elson RA, Engelbrecht E, Lodenkämper H, Röttger J, Siegel A. Management of deep infection of total hip replacement. J Bone Joint Surg Br. 1981; 63:342–353.

18. Raut VV, Siney PD, Wroblewski BM. One-stage revision of infected total hip replacements with discharging sinuses. J Bone Joint Surg Br. 1994; 76:721–724.

19. Winkler H, Stoiber A, Kaudela K, Winter F, Menschik F. One stage uncemented revision of infected total hip replacement using cancellous allograft bone impregnated with antibiotics. J Bone Joint Surg Br. 2008; 90:1580–1584.

20. Takahira N, Itoman M, Higashi K, Uchiyama K, Miyabe M, Naruse K. Treatment outcome of two-stage revision total hip arthroplasty for infected hip arthroplasty using antibiotic-impregnated cement spacer. J Orthop Sci. 2003; 8:26–31.

21. Biring GS, Kostamo T, Garbuz DS, Masri BA, Duncan CP. Two-stage revision arthroplasty of the hip for infection using an interim articulated Prostalac hip spacer: a 10- to 15-year follow-up study. J Bone Joint Surg Br. 2009; 91:1431–1437.

22. Hsieh PH, Shih CH, Chang YH, Lee MS, Shih HN, Yang WE. Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am. 2004; 86:1989–1997.

23. Haddad FS, Muirhead-Allwood SK, Manktelow AR, Bacarese-Hamilton I. Two-stage uncemented revision hip arthroplasty for infection. J Bone Joint Surg Br. 2000; 82:689–694.

24. Okoro T, Lemmey AB, Maddison P, Andrew JG. An appraisal of rehabilitation regimes used for improving functional outcome after total hip replacement surgery. Sports Med Arthrosc Rehabil Ther Technol. 2012; 4:5.

25. Wylde V, Livesey C, Blom AW. Restriction in participation in leisure activities after joint replacement: an exploratory study. Age Ageing. 2012; 41:246–249.

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