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Two-stage hip revision arthroplasty for periprosthetic joint infection without the use of spacer or cemented implants

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Abstract

Introduction

There is no gold standard for performing a two-stage exchange arthroplasty to treat periprosthetic joint infection (PJI). The use of spacers and the anchorage principles of the revision prosthesis remain controversial. Herein, we report the success rate of a two-stage total hip replacement procedure without using a spacer and only pressfit cementless implants.

Methods

Between 2009 and 2015, 57 patients with chronic late-onset PJI were treated using a two-stage prostheses exchange without spacer. The average age was 66.7 years (47–83 years). The mean follow-up was 53.9 ± 25 months. Treatment included microbiologic diagnostics and a high-efficiency antimicrobial therapy in between the operations for six weeks and a two week antibiotic-free interval before reimplantation of the cementless prostheses. After implantation, antibiotics were stopped. This study was approved by the institutional review board.

Results

Ninety-six percent of the patients had prior unsuccessful PJI treatment in other hospitals. The most common microorganism was Staphylococcus epidermidis (50.9%), followed by Propionibacterium acnes (17.5%) and Staphylococcus aureus (14%). In 42.1% cases, mixed infections were found. All patients could be treated using a cementless implant. In 91.2%, PJI remission was achieved, while 8.6% had chronic PJI with implant retention. Overall, nine prostheses (15.8%) were replaced owing to ongoing PJI or fractures. Mean modified Harris Hip Score was 60.85 (range: 22–88). None of the patients died.

Conclusion

We demonstrated a high success rate for two-stage exchange of infected total hip arthroplasty. Spacer-free treatment does not negatively affect success rate or function. Implantation of an uncemented pressfit prosthesis was possible in all patients.

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Authors and Affiliations

  1. Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany

    Yves Gramlich, Paul Hagebusch, Philipp Faul, Alexander Klug, Gerhard Walter & Reinhard Hoffmann

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  1. Yves Gramlich
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  2. Paul Hagebusch
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  3. Philipp Faul
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Correspondence to Yves Gramlich.

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Gramlich, Y., Hagebusch, P., Faul, P. et al. Two-stage hip revision arthroplasty for periprosthetic joint infection without the use of spacer or cemented implants. International Orthopaedics (SICOT) 43, 2457–2466 (2019). https://doi.org/10.1007/s00264-019-04297-y

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