Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties: 28 one-stage and 53 two-stage exchanges with a mean follow-up of 7 years
Background and purpose — The use of uncemented revision stems is an established option in 2-stage procedures in patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, in 1-stage procedures, they are still rarely used. There are still no detailed data on radio...
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| Format: | Article |
| Language: | English |
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Medical Journals Sweden
2016-11-01
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| Series: | Acta Orthopaedica |
| Online Access: | http://dx.doi.org/10.1080/17453674.2016.1237423 |
| _version_ | 1818498534676103168 |
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| author | Philipp Born Thomas Ilchmann Werner Zimmerli Lukas Zwicky Peter Graber Peter E Ochsner Martin Clauss |
| author_facet | Philipp Born Thomas Ilchmann Werner Zimmerli Lukas Zwicky Peter Graber Peter E Ochsner Martin Clauss |
| author_sort | Philipp Born |
| collection | DOAJ |
| description | Background and purpose — The use of uncemented revision stems is an established option in 2-stage procedures in patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, in 1-stage procedures, they are still rarely used. There are still no detailed data on radiological outcome after uncemented 1-stage revisions. We assessed (1) the clinical outcome, including reoperation due to persistent infection and any other reoperation, and (2) the radiological outcome after 1- and 2-stage revision, using an uncemented stem. Patients and methods — Between January 1993 and December 2012, an uncemented revision stem was used in 81 THAs revised for PJI. Patients were treated with 1- or 2-stage procedures according to a well-defined algorithm (1-stage: n = 28; 2-stage: n = 53). All hips had a clinical and radiological follow-up. Outcome parameters were eradication of infection, re-revision of the stem, and radiological changes. Survival was calculated using Kaplan-Meier analysis. Radiographs were analyzed for bone restoration and signs of loosening. The mean clinical follow-up time was 7 (2–15) years. Results — The 7-year infection-free survival was 96% (95% CI: 92–100), 100% for 1-stage revision and 94% for 2-stage revision (95% CI: 87–100) (p = 0.2). The 7-year survival for aseptic loosening of the stem was 97% (95% CI: 93–100), 97% for 1-stage revision (95% CI: 90–100) and 97% for 2-stage revision (95% CI: 92–100) (p = 0.3). No further infection or aseptic loosening occurred later than 7 years postoperatively. The radiographic results were similar for 1- and 2-stage procedures. Interpretation — Surgical management of PJI with stratification to 1- or 2-stage exchange according to a well-defined algorithm combined with antibiotic treatment allows the safe use of uncemented revision stems. Eradication of infection can be achieved in most cases, and medium- and long-term results appear to be comparable to those for revisions for aseptic loosening. |
| first_indexed | 2024-12-10T20:16:57Z |
| format | Article |
| id | doaj.art-fbdf5f100b58423ab6f1388f9c3ba0bf |
| institution | Directory Open Access Journal |
| issn | 1745-3674 1745-3682 |
| language | English |
| last_indexed | 2024-12-10T20:16:57Z |
| publishDate | 2016-11-01 |
| publisher | Medical Journals Sweden |
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| series | Acta Orthopaedica |
| spelling | doaj.art-fbdf5f100b58423ab6f1388f9c3ba0bf2022-12-22T01:35:10ZengMedical Journals SwedenActa Orthopaedica1745-36741745-36822016-11-0187663764310.1080/17453674.2016.12374231237423Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties: 28 one-stage and 53 two-stage exchanges with a mean follow-up of 7 yearsPhilipp Born0Thomas Ilchmann1Werner Zimmerli2Lukas Zwicky3Peter Graber4Peter E Ochsner5Martin Clauss6Department of Orthopedics and Trauma Surgery andInterdisciplinary Unit for Orthopedic Infections, Kantonsspital BasellandInterdisciplinary Unit for Orthopedic Infections, Kantonsspital BasellandDepartment of Orthopedics and Trauma Surgery andInterdisciplinary Unit for Orthopedic Infections, Kantonsspital BasellandDepartment of Orthopedics and Trauma Surgery andDepartment of Orthopedics and Trauma Surgery andBackground and purpose — The use of uncemented revision stems is an established option in 2-stage procedures in patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, in 1-stage procedures, they are still rarely used. There are still no detailed data on radiological outcome after uncemented 1-stage revisions. We assessed (1) the clinical outcome, including reoperation due to persistent infection and any other reoperation, and (2) the radiological outcome after 1- and 2-stage revision, using an uncemented stem. Patients and methods — Between January 1993 and December 2012, an uncemented revision stem was used in 81 THAs revised for PJI. Patients were treated with 1- or 2-stage procedures according to a well-defined algorithm (1-stage: n = 28; 2-stage: n = 53). All hips had a clinical and radiological follow-up. Outcome parameters were eradication of infection, re-revision of the stem, and radiological changes. Survival was calculated using Kaplan-Meier analysis. Radiographs were analyzed for bone restoration and signs of loosening. The mean clinical follow-up time was 7 (2–15) years. Results — The 7-year infection-free survival was 96% (95% CI: 92–100), 100% for 1-stage revision and 94% for 2-stage revision (95% CI: 87–100) (p = 0.2). The 7-year survival for aseptic loosening of the stem was 97% (95% CI: 93–100), 97% for 1-stage revision (95% CI: 90–100) and 97% for 2-stage revision (95% CI: 92–100) (p = 0.3). No further infection or aseptic loosening occurred later than 7 years postoperatively. The radiographic results were similar for 1- and 2-stage procedures. Interpretation — Surgical management of PJI with stratification to 1- or 2-stage exchange according to a well-defined algorithm combined with antibiotic treatment allows the safe use of uncemented revision stems. Eradication of infection can be achieved in most cases, and medium- and long-term results appear to be comparable to those for revisions for aseptic loosening.http://dx.doi.org/10.1080/17453674.2016.1237423 |
| spellingShingle | Philipp Born Thomas Ilchmann Werner Zimmerli Lukas Zwicky Peter Graber Peter E Ochsner Martin Clauss Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties: 28 one-stage and 53 two-stage exchanges with a mean follow-up of 7 years Acta Orthopaedica |
| title | Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties: 28 one-stage and 53 two-stage exchanges with a mean follow-up of 7 years |
| title_full | Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties: 28 one-stage and 53 two-stage exchanges with a mean follow-up of 7 years |
| title_fullStr | Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties: 28 one-stage and 53 two-stage exchanges with a mean follow-up of 7 years |
| title_full_unstemmed | Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties: 28 one-stage and 53 two-stage exchanges with a mean follow-up of 7 years |
| title_short | Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties: 28 one-stage and 53 two-stage exchanges with a mean follow-up of 7 years |
| title_sort | eradication of infection survival and radiological results of uncemented revision stems in infected total hip arthroplasties 28 one stage and 53 two stage exchanges with a mean follow up of 7 years |
| url | http://dx.doi.org/10.1080/17453674.2016.1237423 |
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