Study On The Midterm Follow-up After Total Hip Arthroplasty In The Treatment Of Suppurative Arthritis

BackgroundPyogenic hip arthritis occurs most often in young patients. Delayed treatment causes significant anatomical deformation of bony and soft tissue structures leading to premature onset of secondary osteoarthritis. Total hip arthroplasty (THA) in patients who had osteoarthritis secondary to hip pyogenic infection has been associated with high complication rates.MethodsThere were17males and22females, the average age of infection was10.6years (range7-13years) and the average quiescent period of infection was29.5years (range22-41years). The count of white blood cell (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were examined routinely before surgery. The duration of followup was34months (range6-52months).ResultsThere was no evidence of infection according to laboratory values, intraoperative exploration and bacterial culture of joint fluids and synovial tissues. Split fracture above the lesser trochanter occurred in two hips and healed without adverse sequelae after fixation with wires. One patient with sciatic nerve palsy was successfully treated by positioning the hip in extension and the knee in flexion with complete resolution of motor symptoms one month later. There were no cases of dislocation, deep vein thrombosis, or postoperative reinfection. The symptoms and hip joint activities were significantly improved. The median Harris hip score improved from47.3preoperatively to89.7and the median range of motion from53°to125°.ConclusionsIt is safe and efficient to perform THA in patients who had osteoarthritis secondary to pyogenic hip arthritis when the infection is quiescent. The key points of successful surgery are exclusion of active infection preoperatively, quiescent period of infection more than ten years and adequate intraoperative soft tissue releases.