Two-stage Revison For Treatment Of The Infected Hip Arthroplasty

Objective To investigate the diagnosis of infection after hip arthroplasty and the effect of two-stage revision for treatment of the infected hip arthroplasty.Methods From January 2005 to August 2007, 15 patients with infection after hip arthroplasty were analyzed retrospectively. There were 7 males and 8 females with the average age of 62 years old (range 48～79). Hip pain occurred in all 15 patients and fistula in 8 patients; Abnormal erythrocyte sedimentation rate (ESR) was observed in 14 cases and the increased C-reactive protein (CRP) in 14 patients; Radiography findings, such as osteolysis, loosening and periosteal reaction, were presented on 14 patients; 4 cases had positive culture result in secreta of fistula preoperatively and intraoperative tissue. The other 11 cases had negative culture result; And in all cases, purulent fluid and inflamed-appearing granulation tissue were seen and the intraoperative frozen section had more than five polymorphonuclear leucocytes per high-power field. All patients were treated using the two-stage protocol. In the first stage operation, the following steps were performed, complete debridement, removal of infected prosthesis, implantation of a temporary cement spacer with vancomycin impregnated, and postoperative treatment involved concomitant administration of 2 weeks of intravenous (IV) and 6 weeks of oral. The second stage procedure was taken only when the wound had healed, the erythrocyte sedimentation rate and C-reactive protein returned to the normal levels. The outcomes were evaluated by using the Harris Hip Score System.Results 15 cases obtained primary healing of incision after the first debridement and implantation of cement spacer with vancomycin impregnated. And 14 cases were treated with two-stage revision, the interval between primary and secondary procedures was 5.3 months in average. No sign of postoperative recurrent infection was found in these cases with the mean follow-up of 13.8 months, and the mean Harris Hip Score was increased from 32.3 points before operation to 80.7 points after operation at the latest follow-up (P<0.01).Conclusion (1) There is no standard single reliable test is able to show the presence of infected hip arthroplasty in every case, and a combined approach using assessment of clinical symptoms, serologic tests, diagnostic imaging, intra-operative appearance, microbiological analysis and tissue biopsy can enable the diagnosis of infection to be made with a high degree of confidence; (2) Two-stage revision is a very effective method in the treatment of infected hip arthroplasty because of higher eradication rate of the infection and good postoperative functional result.