Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2017; 8(3): 264-270
Published online Mar 18, 2017. doi: 10.5312/wjo.v8.i3.264
Results of single stage exchange arthroplasty with retention of well fixed cement-less femoral component in management of infected total hip arthroplasty
Wael A Rahman, Hussain A Kazi, Jeffery D Gollish
Wael A Rahman, Orthopaedic Department, Mansoura University, Mansoura, Dakahlia 35516, Egypt
Wael A Rahman, Hussain A Kazi, Jeffery D Gollish, Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4Y 1H1, Canada
Hussain A Kazi, Mid Cheshire Hospitals, NHS Foundation Trust, Leighton Hospital, Crewe, Cheshire CW1 4QJ, United Kingdom
Author contributions: Gollish JD did all the surgeries, designed the research, and critically revised the manuscript; Kazi HA collected the data, analyses the data; Rahman WA collected the data, analyzed the data, wrote the manuscript.
Institutional review board statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved with institutional review board of sunny brook health science hospital University of Toronto. Toronto, Ontario, Canada.
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: This study was not funded by any institution. The authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Wael A Rahman, MBBCh, MSc, MD(Ortho), Assistant Professor, Orthopaedic Department, Mansoura University, 60 El-Gomhoria street, Mansoura, Dakahlia 35516, Egypt.
Telephone: +20-127-9206665
Received: June 4, 2016
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.

Keywords: Total hip arthroplasty, Infection, One stage exchange, Complication

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.