Total Hip Arthroplasty In Adult Patients With Osteoarthrosis Due To Hip Infection Sequela

Objective:To discuss the surgery key points and short-term effectiveness of total hip arthroplasty(THA)in adult patients with osteoarthrosis due to hip infection sequela.Methods:From August 2012 to November 2018,THA was carried out on 16 cases(16 hips)with osteoarthrosis due to hip infection sequela in our division.Thirteen cases were males and 3 cases were females,aged from 32 to 70,with an average age of 49.4 years old.There were 8 cases of pyogenic infection,2 cases of brucella infection,1 case of tuberculous infection,and 5 cases were uncertain.The average period of quiescent infection was 11.9 months,and the mean interval from initial infection to primary THA was 13.2 months,with an average follow-up of 23 months.The posterolateral approach was applied in all the reviewed patients.According to X-ray the acetabular and femoral deformities were classified by Kim,s classification system.The infection was evaluated by laboratory examinations and vital signs intraoperatively and postoperatively.Hip X-ray was used to evaluate the stability of the prosthesis and whether there was periprosthetic osteolysis.The clinical effect was measured with Harris hip scoring system preoperatively and postoperatively.Results:All the 16 patients were followed up for 4-74 months,with an average of 23 months.According to Kim,s classification,three cases(20%)were type I,four cases(25%)were type Ⅱand nine cases were type Ⅲ(55%).Pathological examination and bacterial culture were used to detect intraoperative excised specimens.The results were all negative.One case of femoral fracture occurred intraoperatively.One stage healing of theincision were obtained in all patients.No sciatic nerve palsy,hip dislocation or deep vein thrombosis were founded in 16 patients.At the final review,there was noswelling in the affected hip joint,no skin temperature increased,and no infection occurred during the follow-up period.Trendelenburg sign happened in none of our cases.From X-ray view,no acetabular implant displacement(> 2 mm)or abduction angle change was tested.No stem subsidence occurred.The average Harris hip score pre-operatively and post-operatively were 35.4and 92.7 respectively,which was statistically different(t =23.300 P < 0.05).Conclusion:Total hip arthroplasty in Patients with a history of hip infection after the quiescent period of infection can achieve a satisfactory curative effect in the early stage.Strict preoperative case selection and evaluation,good surgical skills and correct prosthesis selection are the keys to obtain good postoperative efficacy,and the risk of recurrence of infection was low.