Conservative two-stage revision with primary components of infected total hip arthroplasty: An analysis of survival, clinical and radiographic outcomes

PLoS One. 2020 Oct 1;15(10):e0239981. doi: 10.1371/journal.pone.0239981. eCollection 2020.

Abstract

Few studies provide an analysis of conservative two-stage revision of hip periprosthetic joint infection (PJI) and its impact on final outcome. A conservative revision is defined when soft tissues and bone quality enable the use of primary prosthetic components. Data of patients treated for chronic hip PJI who underwent two-stage revision between 2009 and 2016 and had a minimum of 2 years of follow-up were collected. Oxford Hip Score (OHS), Harris Hip Score (HHS) and radiological and microbiological data were retrieved and analysed. Clinical and functional outcome, survival, mortality, eradication, reinfection and re-revision rates within subgroups of patients with primary components and revision components are reported herein. A total of 148 patients underwent two-stage hip exchange with a mean follow-up of 55.6 ± 23.1 months and a mean age at surgery of 64.3 ± 12.7 years. Forty-four percent of patients underwent conservative revision. The mean HHS significantly improved from 40.6 ± 9.4 points to the final value of 87.8 ± 10.5 points (p = .002), and the mean OHS went from 20.3 ± 3.8 points to 40.3 ± 5. points (p< .001). Patients who were treated with primary components or isolated revision stems in the second stage had a significant reduction in surgical times (p< .001). The mortality rate for all causes of death was 6.8%, the eradication rate was 89.9%, the reinfection rate was 4.7% and the reoperation rate was 7.4% without differences between conservative and non-conservative revisions. Two-stage exchange arthroplasty for total hip arthroplasty (THA) PJI is a good strategy that provides satisfactory results, high eradication rates and no further need for revision. The conservative two-stage revision in patients with adequate bone stock represents a feasible option with good results and survival rates.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prosthesis-Related Infections / diagnostic imaging*
  • Prosthesis-Related Infections / mortality
  • Prosthesis-Related Infections / therapy
  • Recurrence
  • Retrospective Studies
  • Survival Analysis
  • Tomography, X-Ray Computed*
  • Treatment Outcome

Grants and funding

We declare that this research is supported by Department of Surgical Sciences (DISC), Viale Benedetto XV 6, 2nd floor, 16132, Genova, Italy. Authors did not receive any direct founding from Department of Surgical Sciences (DISC). The founding will be only necessary to cover the publication fees. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.