Published online Mar 18, 2017. doi: 10.5312/wjo.v8.i3.264
Peer-review started: June 6, 2016
First decision: July 5, 2016
Revised: November 14, 2016
Accepted: December 1, 2016
Article in press: December 2, 2016
Published online: March 18, 2017
To investigate success of one stage exchange with retention of fixed acetabular cup.
Fifteen patients treated by single stage acetabular component exchange with retention of well-fixed femoral component in infected total hip arthroplasty (THA) were retrospectively reviewed. Inclusion criteria were patients with painful chronic infected total hip. The patient had radiologically well fixed femoral components, absence of major soft tissue or bone defect compromising, and infecting organism was not poly or virulent micro-organism. The organisms were identified preoperatively in 14 patients (93.3%), coagulase negative Staphylococcus was the infecting organism in 8 patients (53.3%).
Mean age of the patients at surgery was 58.93 (± 10.67) years. Mean follow-up was 102.8 mo (36-217 mo, SD 56.4). Fourteen patients had no recurrence of the infection; one hip (6.7%) was revised for management of infection. Statistical analysis using Kaplan Meier curve showed 93.3% survival rate. One failure in our series; the infection recurred after 14 mo, the patient was treated successfully with surgical intervention by irrigation, and debridement and liner exchange. Two complications: The first patient had recurrent hip dislocation 12 years following the definitive procedure, which was managed by revision THA with abductor reconstruction and constrained acetabular liner; the second complication was aseptic loosening of the acetabular component 2 years following the definitive procedure.
Successful in management of infected THA when following criteria are met; well-fixed stem, no draining sinuses, non-immune compromised patients, and infection with sensitive organisms.
Core tip: Peri-prosthetic hip infection is a devastating complication: We hypothesized that a well-fixed circumferentially ingrown cement-less stem can act as a shield and prevent the spread of pathogens and formation of biofilm around the body of the femoral stem. Therefore, single stage exchange of the acetabular component with retention of the well-fixed femoral component can be a successful option in management of infected total hip arthroplasty, when the following criteria are met; well-fixed femoral component, no draining sinuses, non immune compromised patients, and infection with sensitive organisms.