[One-stage revision operations for infection after hip arthroplasty]

Hu Gao, Houshan Lv
Chinese Journal of Reparative and Reconstructive Surgery 2008, 22 (1): 5-8

OBJECTIVE: To disscuss the therapeutic method of the postoperative infection after hip arthroplasty and compare the results of one-stage revision and two-stage revision.

METHODS: From January 1999 to December 2005, 15 cases of infection after hip arthroplasty were treated, including 10 males and 5 females, with a mean age of 63 years (54-71 years). The locations were left hip in 8 cases and right hip in 7 cases. The first operation was hip prosthesis replacement in 6 cases and tatol hip arthroplasty in 9 cases. Infection occurred after 1 month in 6 cases and after 6 months in 9 cases. The preoperative temperature and ruting blood test were normal, the mean erythrocyte sedimentation rate (ESR) was 61 mm/h (34-80 mm/h), mean C-reactive protein (CRP) was 11.7 mg/L (5.4-21.0 mg/L). The mean Harris score was 33 (25-40). The X-ray films showed that periosteal reaction, osteolysis and loosening of prosthesis occurred. The time from the first operation to revision operation was 1-41 months (mean 7.3 months). The results of bacterial culture were positive in 11 cases. One-stage revision was performed in 10 cases, two-stage revision was performed in 5 cases.

RESULTS: Of 15 cases, 6 were classified as early postoperative infection, 9 cases as late chonic infection. The microorganism cultures results of joint aspiration or pus in sinus were positive in 11 cases and negative in 4 cases before operation and during operation; 8 had staphylococcus epidermids infection, 2 escherichia coli infection and 1 staphylococcus aureus infection. Incision of revision operation healed by first intention. No re-infection, swelling and tenderness occurred after 19 months (12-37 months) of follow-up. Pain of hip joint disappeared in 14 cases, and only 1 case had mild pain when walking. ESR and CRP after operation decreased to normal range. The mean Harris score increased significantly to 84.2 (79-92) after revision, showing significant difference when compared with that before operation (P < 0.05).

CONCLUSION: For postoperative infection after total hip arthroplasty, it is still possible to have satisfactory clinical outcome by one-stage or two-stage revision as long as clear diaglosis and correct treatment can made.

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