CEMENTLESS REVISION HIP ARTHROPLASTY FOR INFECTION

Abstract

Introduction: Infected hip arthroplasties have usually been managed with either one or two stage revisions using antibiotic impregnated cement to fix the components. The use of cementless fixation has been less widely reported. The results on the femoral side have been less encouraging.

Aim: To present the short to medium term results of cementless revision for infected hip arthroplasty.

Methods: Ten patients who had undergone cementless revisions for infected hip arthroplasties have been followed prospectively. There were eight males and two females with an average age of 67 years. Nine of the 10 patients were treated with two-stage revisions with one female undergoing a one-stage revision for medical reasons. The diagnosis of sepsis was made on the basis of bacterial cultures and positive histology from all patients. Removal of the prosthesis was followed by the administration of intravenous antibiotics for six weeks and, in some, cases oral antibiotics for several months. The reconstructions were undertaken following the Girdlestone’s arthroplasties with a range from eight weeks to three years, (with the exception of the one stage exchange).

Results: The patients were examined from 18 to 64 months after the surgery with none lost to follow-up. All prostheses remained in situ with improvements in the Charnley and Oxford hip scores. There had been no recurrence of infection and no clinical or radiological evidence of loosening.

Discussion: Debate still exists about the merits of one-stage versus two-stage reconstruction for an infected hip arthroplasty. The use of antibiotic-impregnated cement has been recommended, especially for the femoral component. This series demonstrated that cementless reconstruction for infected hip arthroplasty was successful in providing an infection free, stable hip in the short to medium term.