Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties.
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...
| Published in: | Acta Orthopaedica Vol. 87; no. 6; pp. 637 - 644 |
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| Main Authors: | , , , , , , |
| Format: | algorithm diagnostic images research tables/charts Journal Article |
| Published: |
Medical Journals Sweden AB
Dec2016
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119476023&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 119476023 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 17453674 1BVL jtl: Acta Orthopaedica issn: 17453674 maglogo: N pubinfo: dt: Dec2016 vid: 87 iid: 6 pid: 59195 pub: Medical Journals Sweden AB artinfo: ui: 119476023 119476023 119476023 10.1080/17453674.2016.1237423 119476023 ppf: 637 ppct: 7 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties. aug: au: Born, Philipp Ilchmann, Thomas Zimmerli, Werner Zwicky, Lukas Graber, Peter Ochsner, Peter E Clauss, Martin affil: Department of Orthopedics and Trauma Surgery and sug: subj: Arthroplasty, Replacement, Hip Adverse Effects Prosthesis-Related Infections Drug Therapy Reoperation Treatment Outcomes Survival Analysis Hip Radiography Bone Cements Prostheses and Implants Adverse Effects Human Kaplan-Meier Estimator Confidence Intervals Prosthesis Failure Antibiotics Therapeutic Use ab: 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. pubtype: Academic Journal doctype: algorithm diagnostic images research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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