Is hip resection arthroplasty a successful definitive treatment?

Laia Brunet; Jenaro A Fernández-Valencia; Pere Torner; Lluís Font-Vizcarra; Francesc Anglès; Ernesto Muñoz-Mahamud

doi:10.1016/j.jor.2022.11.008

Is hip resection arthroplasty a successful definitive treatment?

J Orthop. 2022 Nov 17:35:93-98. doi: 10.1016/j.jor.2022.11.008. eCollection 2023 Jan.

Authors

Laia Brunet^{1

2}, Jenaro A Fernández-Valencia^{1

3}, Pere Torner¹, Lluís Font-Vizcarra², Francesc Anglès^{2

3}, Ernesto Muñoz-Mahamud¹

Affiliations

¹ Hospital Clínic de Barcelona, Universitat de Barcelona (Hip Unit. Department of Orthopaedics and Trauma Surgery), Barcelona, Catalonia, Spain.
² Hospital Universitari Mútua de Terrassa, Universitat de Barcelona (Arthroplasty and Musculoskeletal Infection Unit. Department of Orthopaedics and Trauma Surgery), Terrassa, Catalonia, Spain.
³ Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Catalonia, Spain.

Abstract

Purpose: Hip resection arthroplasty as a definitive treatment is an uncommon indication, although still in use selectively. This study evaluates a cohort of patients who have undergone hip resection arthroplasty surgery indicated as a definitive treatment, in order to assess the rate of re-operation, the rate of infection, and the mortality rates.

Methods: We conducted a retrospective, observational, descriptive analysis of a cohort of patients who had undergone a hip resection arthroplasty intended as a definitive treatment, in two University Hospitals from 1994 to 2020. The exclusion criteria were the implantation of a hip cement spacer, or a temporary hip resection arthroplasty in patients undergoing a two-staged surgical approach. We found 26 cases of hip resection arthroplasty. We recorded the indications for a definitive hip resection arthroplasty, the outcomes and complications, and analyzed the success of the hip resection arthroplasty as a definitive surgery using a Kaplan-Meier curve.

Results: Seven cases (26.9%) required a re-operation after the hip resection arthroplasty, four cases for persistent hip infection, and in the three remaining a conversion to a total hip arthroplasty was re-considered due to a good medical evolution and non-tolerance to the low functional outcome. The mortality rate was 61.5% (27 days-20 years), with a 19.2% mortality rate in the first 5 years. All the cases that required another surgery after the hip resection arthroplasty were re-operated within the first 18 months.

Conclusion: Unfortunately, hip resection arthroplasty continues to show elevated re-operation rate and early mortality rate, as well as low functional outcomes. Two-staged hip revision arthroplasty is the surgical treatment of choice in patients suffering from a periprosthetic joint infection, however we believe that hip resection arthroplasty should be considered in fragile patients, who have endured multiple revision surgeries, or their comorbidities make them unfit from further surgeries.

Keywords: Excision arthroplasty; Girdlestone arthroplasty; HRA; HRA, Hip resection arthroplasty; Hip resection arthroplasty; PJI; PJI, Periprosthetic joint infection; Periprosthetic joint infection; THA, Total hip arthroplasty; TJA, Total joint arthroplasty.