Authors: Kenichi Oe Hirokazu Iida Narumi Ueda Tomohisa Nakamura Naofumi Okamoto Yusuke Ueda
Publish Date: 2014/08/17
Volume: 39, Issue: 1, Pages: 19-25
Abstract
We constructed a 12point preoperative scoring system to suggest either one or twostage revision THAs based on a retrospective analysis of 55 operative procedures Prosthesis survival was analysed using the KaplanMeier method and the validity of the scoring system was evaluated using receiveroperating characteristic curvesAt the end point of implant removal due to recurrent infection the ten year survival rates were 94 and 87 for one and twostage revision THAs respectively Onestage revision THA was recommended for patients scoring 9 points The risk of recurrent infection in patients scoring 4 points was 83 The sensitivity and specificity of a cutoff value of 4 points determined by the scoring system were 83 and 100 respectivelyTreatments for periprosthetic hip infections remain controversial and are particularly challenging because most patients require implant removal In North America the gold standard treatment for periprosthetic hip infection is twostage revision total hip arthroplasty THA In contrast in Europe onestage revision THA which includes replacement of the prosthesis during the same surgical procedure is often preferred This is likely because onestage revision THA usually employs an antibioticloaded acrylic cement ALAC 1 and for over a decade the North American trend has been towards the use of ‘cementless’ techniques According to some metaanalyses the infection control rate in twostage revision THAs using ALAC was 88–93 whereas that for onestage revision THAs also with ALAC was 82–86 2 3 4 5 On the other hand without ALAC infection control was achieved in 82–91 of twostage revision THA cases and in 56–59 of onestage revision THAs 2 3 4 5 The twostage revision THA is safe but has the disadvantages of requiring a second operation and having higher associated costs Currently there are algorithms and staging systems for periprosthetic hip infections 6 7 8 9 10 so it may be common for surgeons to employ one or twostage revision THA as the situation demands However a scoring system is not available to definitively determine the appropriate surgical strategy for patients with periprosthetic hip infectionsWe performed one and twostage revision THAs for periprosthetic hip infection according to various published criteria 6 7 9 10 11 12 Here we attempted to set up a scoring system for the preoperative evaluation of one and twostage revision THAs based on a retrospective analysis of 55 cases The aim of this study was to report the scoring system and to determine a rational surgical treatment strategy The hypothesis of the study was that a scoring system would facilitate better management of periprosthetic hip infectionsIn accordance with published criteria 6 7 9 10 11 12 onestage revision THA was performed if 1 the patient’s general condition was good 2 wound complications were absent 3 the pathogens was antibiotic sensitive and 4 the bone defect requiring reconstruction was small Twostage revision THA was performed in cases that did not meet the criteria for onestage revision THA but the final decision was made intraoperatively by the surgeon 14 All patients received cemented THAs with custommixed ALAC according to the reported bacterial sensitivities determined from the preoperative aspirates Over 36 g of antibiotic per 40 g of cement was used in the first stage of twostage revision THAs and 10–20 g of antibiotic per 40 g of cement was used in the second stage of twostage revision THAs and in onestage revision THAs Endurance Bone Cement DePuy International Leeds UK
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