Clinical Analysis Of Two-stage Revision Surgery For Periprosthetic Joint Infection After Hip Arthroplasty

ObjectiveTo analyze the cases of two-stage revision surgery in the treatment of periprosthetic joint infection after total hip arthroplasty,to explore the clinical effect of the surgery,and to discuss the timing of the two-stage surgery.MethodsRetrospective analysis 32 cases from February 2011 to February 2016 in the First Affiliated Hospital of Kunming Medical University,Department of orthopedics were followed up.All cases were received two-stage revision surgery for PJI after THA.There were 19 males and 13 females,the mean age of all subjects was 65.4 years(range,42-75),the mean time of infection after THA was 2.5 years(range,2 months-7 years),14 patients with sinus tract,15 patients had positive bacterial culture result in sinus secretions or joint fluid.28 patients with ESR and CRP were significantly increased,4 patients with elevated CRP,ESR normal.All patients underwent two-stage revision surgery,in the first stage operation,removed the infected necrotic tissue、prosthesis and bone cement prosthesis,implanted homemade joint vancomycin bone cement prosthesis,postoperative use antibiotic treatment.The second stage procedure was taken when infection had controlled,the time interval of 6-16 weeks,the average time is 8weeks.The patients were followed up regularly,and the results were evaluated by Harris score,symptoms and signs,hematology and imaging findings.ResultsAll patients with a debridement after pathological examination are to support the diagnosis of infection,surgical incision were healed.32 patients were followed up for a long time,with a mean follow-up time of 19.5 months(range,12-48 months).Harris score was significant increased from preoperative 31.1 ± 12.3 points to 3 months after operation 58.2 ± 11.0 points,6 months 67.5 ± 10.9 points,1 year 78.2 ± 10.3 points.ESR was reduced from preoperative 43.3 ± 20.4mm/h to 1year 15.1 ±5.9mm/h;CRP decreased from preoperative 43.8 ± 18.6mg/L to 1 year 8.9 ± 5.5 mg/L.To the end of the follow-up,31 patients symptoms and signs were significantly improved,no recurrence of infection,X-ray showed that the prosthesis was in good position,no loosening,osteolysis and other complications,infection control the rate reached 97%,except for 1 cases of femoral stem revision patients had recurrence of infection 13 months after the operation,ESR and CRP remained above normal,symptoms and signs had no obvious improvement,ConclusionsTwo-stage revision surgery is an effective method to treat PJI after THA,Intraoperative debridement,postoperative anti-infective treatment and repair timing is a key factor in the success of surgery.It is the appropriate time for two-stage revision,after debridement when the patients were generally in a stable condition,the symptoms and signs were relieved,ESR and CRP returned to normal and remained stable for one month.