Two-stage Exchange Total Hip Arthroplasty For Infected Hip Surgery

Objective:To evaluate effect of two-stage exchange total hip arthroplasty(THA) using an antibiotic-loaded cement spacer in the treatment of hip infection secondary to hip surgery.Method:From January2007to June2012,16consecutive patients with infected hip secondary to hip surgery, including12males and4females, aged from43to76years (average,60.7±8.2years) were treated with two-stage exchange THA. There were8cases with hip infection afer artifical joint replacement.There were3cases of femoral neck fracture treated with compressions crews fixation,3cases of intertrochanteric fracture treated with DHS, and2cases of early stage femoral head necrosis treated with core decompression and local interventional therapy respectively. Debridement and insertion of antibiotic-loadedcement spacer was performed in the first stage. After eradication of infection, it was converted to THA in the second stage. All patients were followed upregularly. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were tested. Harris score was used to evaluate the function of the hips.Result:All patients were followed up for anaverage of38months (range,6to70months). Fifteen patients were successfully converted to THA after anaverage of14weeks. One patient accepted the second debridement and reinsertion of a spacer after7months owing to the abnormal values of ESR and CRP; this case was converted to THA successfully12weeks after the second debridement. Harris hips core improved from preoperative34.6±3.4to58.8±5.5between the two stages and91.3±6.7at final follow-up. One patient suffered deep vein thrombosis in the infected extremity and pulmonary embolism. There was no reinfection after THA.Conclusion:Two-stage exchange THA using anantibiotic-loaded cement spacer can obtain satisfactory results for the treatment of hip infections econdary to the hip surgery.