Infection and failure rates following total hip arthroplasty for septic arthritis: a case-controlled study

Abstract

Introduction:

Total hip arthroplasty (THA) is performed as a 2-stage or single stage procedure in patients with a history of septic arthritis of the native hip joint. The decision is based on whether the infection is active or quiescent in the joint. The aim of this study was to compare the outcomes of total hip arthroplasty for septic arthritis of the native hip to a control series of patients treated for primary osteoarthritis of the hip with standard THA.

Methods:

Between March 2000 and March 2013, 18 cases of septic arthritis of the hip treated with THA were retrospectively identified. During the same time period, 18 control cases of THA for degenerative osteoarthritis were identified. Cases and controls were comparable in age, gender, body mass index, type of anaesthesia and American Society of Anesthesiologists score.

Results:

11 and 7 cases received 2-stage and single stage total hip arthroplasty respectively for septic arthritis. There was a mean interval of 4 months between 1^st and 2^nd-stage operations. Cases and controls were followed up for a mean of 70 and 72 months respectively. There was no reinfection or implant failure in the cases, and comparable functional outcomes between cases and controls.

Conclusions:

Two-stage and single-stage THA for active and quiescent native hip infection respectively, achieved similar outcomes to THA for primary osteoarthritis in controls.

Keywords

Cement beads Septic arthritis Single stage Total hip arthroplasty Two stage

Get full access to this article

View all access options for this article.

References

Matthews

Dean

BJF

Medagoda

et al . Native hip joint septic arthritis in 20 adults: delayed presentation beyond three weeks predicts need for excision arthroplasty. J Infect. 2008;57(3):185-190.

Gupta

Sturrock

Field

. A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatology (Oxford). 2001;40(1):24-30.

Lenski

Scherer

. Diagnostic potential of inflammatory markers in septic arthritis and periprosthetic joint infections: a clinical study with 719 patients. Infect Dis (Lond). 2015;47(6):399-409.

Bittar

Petty

. Girdlestone arthroplasty for infected total hip arthroplasty. Clin Orthop Relat Res. 1982;170(170):83-87.

Bourne

Hunter

Rorabeck

Macnab

. A six-year follow-up of infected total hip replacements managed by Girdlestones arthroplasty. J Bone Joint Surg Br. 1984;66(3):340-343.

de SA

Cargnelli

Catapano

et al . Efficacy of hip arthroscopy for the management of septic arthritis: a systematic review. Arthroscopy. 2015;31(7):1358-1370.

Romanò

Meani

Logoluso

Drago

. Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study. BMC Infect Dis. 2011;11(1):129.

Anagnostakos

Duchow

Koch

. Two-stage protocol and spacer implantation in the treatment of destructive septic arthritis of the hip joint. Arch Orthop Trauma Surg. 2016;136(7):899-906.

Bauer

Lacoste

Lhotellier

Mamoudy

Lortat-Jacob

Hardy

. Arthroplasty following a septic arthritis history: a 53 cases series. Orthop Traumatol Surg Res. 2010;96(8):840-843.

10.

Huang

Lee

Tai

Hsieh

. Encouraging outcomes of staged, uncemented arthroplasty with short-term antibiotic therapy for treatment of recalcitrant septic arthritis of the native hip. J Trauma. 2010;68(4):965-969.

11.

Chen

Wang

Juhn

. Total hip arthroplasty for primary septic arthritis of the hip in adults. Int Orthop. 2008;32(5):573-580.

12.

Kelm

Bohrer

Schmitt

Anagnostakos

. Treatment of proximal femur infections with antibiotic-loaded cement spacers. Int J Med Sci. 2009;6(5):258-264.

13.

Diwanji

Kong

Park

Cho

Song

Yoon

. Two-stage reconstruction of infected hip joints. J Arthroplasty. 2008;23(5):656-661.

14.

Fleck

Spangehl

Rapuri

Beauchamp

. An articulating antibiotic spacer controls infection and improves pain and function in a degenerative septic hip. Clin Orthop Relat Res. 2011;469(11):3055-3064.

15.

Laforgia

Murphy

JCM

Redfern

. Low friction arthroplasty for old quiescent infection of the hip. J Bone Joint Surg Br. 1988;70(3):373-376.

16.

Jupiter

Karchmer

Lowell

Harris

. Total hip arthroplasty in the treatment of adult hips with current or quiescent sepsis. J Bone Joint Surg Am. 1981;63(2):194-200.

17.

Hardinge

Cleary

Charnley

. Low-friction arthroplasty for healed septic and tuberculous arthritis. J Bone Joint Surg Br. 1979;61(2):144-147.

18.

Kim

. Total hip arthroplasty in adult patients who had childhood infection of the hip. J Bone Joint Surg Am. 2003;85-A(2):198-204.

19.

Joseph

Raman

Macdonald

. Time interval between first and second stage revision hip arthroplasty for infection, the effect on outcome. J Bone Joint Surg Br. 2003;85-B(Suppl):58.

20.

Janssen

Geurts

Jütten

Walenkamp

. 2-stage revision of 120 deep infected hip and knee prostheses using gentamicin-PMMA beads. Acta Orthop. 2016;87(4):324-332.

21.

Nelson

Evans

Blaha

Calhoun

Henry

Patzakis

. A comparison of gentamicin-impregnated polymethylmethacrylate bead implantation to conventional parenteral antibiotic therapy in infected total hip and knee arthroplasty. Clin Orthop Relat Res. 1993;295(295):96-101.

22.

Hsieh

Shih

Chang

Lee

Shih

Yang

. Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am. 2004;86-A(9):1989-1997.

23.

Wolf

Doctor

Manner

Leopold

. Comparison of one and 2-stage revision of total hip arthroplasty complicated by infection: a Markov expected-utility decision analysis. J Bone Joint Surg Am. 2011;93(7):631-639.