Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection?

Fay Leung, Corey J Richards, Donald S Garbuz, Bassam A Masri, Clive P Duncan
Clinical Orthopaedics and related Research 2011, 469 (4): 1009-15

BACKGROUND: Methicillin-resistant hip infections are increasingly common. Reports of the surgical management of these patients using two-stage THA show variable control of infection, but all reports used static spacers.

QUESTIONS/PURPOSES: We therefore determined (1) the rate of successful control of infection and (2) function in patients with methicillin-resistant infection treated with a two-stage THA using an articulated cement spacer during the first stage.

METHODS: We retrospectively reviewed 50 patients who had a two-stage revision THA for methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis infection. Twelve patients died, leaving 38 for review. All eligible patients completed quality-of-life outcome questionnaires (WOMAC, SF-12, Oxford-12, UCLA activity score, hip and knee satisfaction score). Minimum followup was 24 months after the second stage (mean, 58 months; range, 24-123 months).

RESULTS: Of the 38 patients, eight (21%) had recurrence of their infection requiring further revision surgery. Of the remaining 27 patients, the mean WOMAC was 62, mean Oxford-12 60, mean UCLA activity score 4.3, and mean hip and knee satisfaction score 66.

CONCLUSIONS: We found a treatment failure rate of 21% for patients with methicillin-resistant S. aureus or methicillin-resistant S. epidermidis infection. This is a higher rate than reported for two-stage THA for studies including patients infected with both nonresistant and resistant organisms. The functional scores for patients were also lower than those reported in the literature.

LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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