Management Of 2 To 5 Years Follow-up Of The Infection After Total Hip Arthroplasty With Two-stage Revisions

BackgroundWith the gradual increase of people's natural life,the traffic accidents,the traumatism and the congenital disease,today in China many doctors use the total hip arthroplasty(THA) to solve hip disease and traumatism.Postoperative infection after THA is the most severe complication resulting in failure of the procedure to increase the patient's physical and psychological suffering and economic burden.The treatment of infection after THA is very difficult.We can use antibacterial therapy,one-stage revision,two-stage revision and so on.Two-stage revision is usually used to solve late infection.It become recognized as the gold standard of the infection after THA.However there is a lack of the management to estimate the re-infection and functional outcome.ObjectiveWe want to present the experience with two-stage revision in the management of the infected hip arthroplasty to evaluate this method by analyze of the 18 cases. MethodsBetween July,2004 to July 2008,a total of 19 hips in 18 patients were performed the revisions of the total hip replacement.The reason was infection after THA.That follow-up after revision was 2 to 5 years and an average time of 3 years.Among them,10 were male(11 hip) and 8 were female(8 hip),with there ages ranging from 46 to 72 and an average age of 69.8 years.The arthroplasty in 18 patients,10 left,8 right and 1 bilateral.The reasons of primary replacement include avascular necrosis of the femoral head(12),fracture of femoral neck(5),rheumatoid arthritis(1).All of them were infected after primary total hip arthroplasty.First 18 patients were performed thorough debridement,and then implanted antibiotic-loaded cement prosthesis as an interim spacer.When the infection was cured we could perform two-stage revision.The interval was 4 months to 12 months and an average time of 5.8 months.ResultNone of 18 patients had reinfection..The preoperative Harris Hip Score averaged 31.1(12-39) points.The postoperative Harris Hip Score averaged 87.2(71-97) points, up by 56.1 points over the preoperative.The laboratory investigation and imaging examination showed normally.ConclusionTwo-stage revision is an effective method to treat postoperative infection after total hip arthroplasty.It has high rate of eradication of the infection and satisfactory postoperative functional result.