Abstract
Introduction: Bone stock and cement-bone interface in revision total hip replacement (THR) for deep infection have never been investigated in the literature, while they are known to be important for aseptic loosening. The purpose of this study was to assess preoperative bone stock and immediate postoperative cement-bone interface as factors affecting infection control and mechanical outcome after revision THR for deep infection.
Methods: This study included 115 cases in which revision THR with antibiotic-loaded cement was operated for infected hip replacement by a single surgeon with minimal follow-up of five years (range 5–27 years). Preoperative bone stock was classified into four grades (Grade 0: No bone loss, Grade 1: Demarcation, Grade 2: Localized cavitation, Grade 3: Extensive bone loss). The immediate postoperative cement-bone interface was also graded into four categories (Grade A: White-out, obscure interface, Grade B: Clear line, no measurable gap, Grade C: Gap> 1mm, Grade D< 1mm). These two factors were analysed with regard to infection control and mechanical survival of implants after surgery.
Results: Bone stock did not have significant influence on infection control while it affected mechanical outcome. The cement-bone interface was an affecting factor for not only the mechanical survival of implants but also the cure of infection.
Discussion: There was a good chance of curing the infection even with extensive bone loss. Good cement fixation was an important factor with regard to infection control as well as the mechanical survival of implants. The results suggested that it might be important to shield the medullary space from the infected joint space with antibiotic-loaded cement.
Correspondence should be addressed to The Secretary, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
