One-Stage Revision For Treatment Of The Infected Hip Arthroplasty

Objective: To investigate the diagnosis of infection after hip arthroplasty and the effectof one-stage revision for treatment of the infected hip arthroplasty.Methods: From October2007to December2009，9patients with infection after hiparthroplasty were analyzed retrospectively. There were5males and4females with theaverage age of54.6years old (range20~82). Hip pain occurred in all9patients andfistula in2patients; Abnormal erythrocyte sedimentation rate (ESR) was observed in9cases and the increased C-reactive protein (CRP) in7patients; Radiography findings，such as osteolysis，loosening and periosteal action were presented on all9patients;4cases had positive culture results secreta of fistula preoperatively and intraoperativetissue. The other5cases had negative culture result; And in all cases，purulent fluid andinflamed-appearing granulation tissue were seen and the intraoperative frozen sectionhad more than five polymorphonuclear leucocytes per high-power field with thelymphocytes and plasma cells as well; pus culture and sensitivity test to give further;All patients were treated using the one-stage revision. In the operation，the followingsteps were performed，removal of infected prosthesis and suspicious tissue，completedebridement；All surgical fields were irrigated with a pulsed lavage system thoroughlywith a large sodium chloride、 hydrogen peroxide and metronidazole then immersedwith iodophors, implanted a new prosthesis antibiotic-loaded cement，regularlyvancomycin been used, as a replacement.And postoperative treatment involvedconcomitant administration of antibiotics for2weeks of intravenous (IV) and6-12weeks of oral. The patient should to have a rest, while giving the body supportand strengthen the nutrition therapy, the review of ESR and CRP were monitored everytwo weeks; The outcomes were evaluated by using the Harris HIP Score System.Result:9cases were all cured after the one-stage revision. No recurrence of infectionoccurred in these cases with the mean follow-up of29months， and the mean HarrisHip Score was increased from36.9points before operation to85.5points afteroperation at the latest follow-up(P<0.005). Patient Satisfaction: very satisfied with the3 cases, satisfactory in5cases, also the line in1case, no dissatisfaction, patientsatisfaction was88.88%.Conclusions:(l)There is no standard single reliable test is able to show the presence ofinfected hip arthroplasty in every case， and a combined approach using assessmentof clinical symptoms， serologic tests， diagnostic imaging，intraoperative appearance，microbiological analysis and tissue biopsy can enable the diagnosis of infection to bemade with a high degree of confidence.(2)One-stage revision is a very effective methodin the treatment of infected hip arthroplasty by using a perfect local treatment andsystemic support therapy, and it had been accepted by many patients and doctorsgradually, so the previous indications should be relaxed as well，and found a newcriterion.