Treatment Of Periprosthetic Joint Infection After Total Hip Arthroplasty With Partial Two-stage Revision

Objective:To evaluate the effectiveness and result of partial two-stage revision for hip periprosthetic infectionMethods:A retrospective study was measured for 11 patients who received two-stage revision for hip periprosthetic infection in the department of Henan Provincial People’s Hospital of Henan University Joint Orthopaedic department from December 2012 to December 2018.7 cases only removed the acetabular component,4 cases only removed the femoral stem.Of them,6 males and 5 females aged(56.27±21.73)years on average.There were 4 cases of femoral neck fracture,3 cases of Osteonecrosis of the Femoral Head,2 cases of ankylosing spondylitis,1 case of rheumatoid arthritis and 1 case of DDH.In terms of complications,2 cases had hypertension,1 case had hyperlipidemia complicated with right common femoral artery plaque and 1 case with type 2 diabetes.At the time of admission,the incision site of all patients was accompanied by different degrees of redness,swelling and skin temperature rise.In 4 cases,there was a sinus near the incision and it was connected with the joint.ESR,CRP and blood routine examination were completed upon admission.Alternatively,synovial fluid or articular soft tissue was sent for bacterial culture,organism-specific antibiotics were administered intravenously post-operation.Patients were seen in followup regularly until two years.Every time they need to take a x-ray film of pelvis,and reexamine the blood routine,CRP,ESR and other infection indexes.Harris score and visual analogue scale were given by the same physician.The outcome of infection index and VAS were recorded,the function of hip joint was evaluated by Harris scoreOutcome:1.There were 11 patients with hip periprosthetic infection in this group,including 5 patients with positive bacterial culture,the positive rate of bacterial culture was 45.6%;3 patients with Staphylococcus aureus,27.3%,1 patient with Staphylococcus epidermidis,9%,1 patient with Escherichia coli,and the other 6 patients with negative bacterial culture2.Nine patients were followed up for an average of 34.3 months,during which there was no recurrence.The incision and sinuses healed well and the pain was alleviated.The average Harris score of hip joint was 44.33 before operation and 85.34 at the last follow-up.The average score of Harris of hip joint at the last time was higher than that before operation,the difference was statistically significant(t=-11.77,P<0.001),The average VAS was 6.89 before operation and 1.44 at the last follow-up.The average VAS at the last time was lower than that before operation,the difference was statistically significant(t=12.25,P<0.001)One patient failed,the sinus was not healed,the bacterial culture result of this case was Staphylococcus aureus;one patient did not undergo revision operation for 13 weeks,this case The results of bacterial culture were Staphylococcus epidermidis.Results:This study suggests that partial two-stage revision is suitable for:(1)patients with Tsukayama IV PJI;(2)only acetabulum cup or femoral shaft side prosthesis was loose;(3)mixed bacteria,fungus or mycobacterium tuberculosis were excluded;(4)elderly patients with basic diseasesTo sum up,under the condition of strict indications,partial two-stage revision can shorten the operation time,reduce the difficulty of the second revision,and obtain good infection control.It is an effective way to treat the infection around the hip prosthesis.