Abstract
Aim
To evaluate the efficacy of infection elimination and functional outcomes of the resection hip arthroplasty (RHA) with m. vastus lateralis flap plasty in patients with chronic recurrent periprosthetic joint infection (PJI) one year or later after the surgery.
Method
We retrospectively studied the outcomes of 61 cases with recurrent PJI (more than 3 relapses). All patients underwent RHA with m. vastus lateralis flap plasty from the year 2005 to 2016. There were 35 males (63.6%) and 20 females (36.4%) with the mean age of 54 years. At least in one year after the surgery, the cases were analyzed for the absence of inflammation during the physical exam, functional result with the Harris hip score (HSS), quality of life with the Instrument for measurement of health-related quality of life scale and level of pain with the visual analogue scale (VAS). The results are presented as means with CI95%.
Results
The mean follow-up period was 40.8 months. The overall mortality rate was 12.2% (n = 6). Of all patients, 3 (5.5%) had severe concomitant pathology and died due to systemic infection within 90 days after the surgery. Two more patients died during the period of 1–3 years. Prolonged remission of PJI was achieved in 91% (n = 50) patients. In 9% of cases (n = 5) the relapse of infection was achieved.
The HHS corresponded to an unsatisfactory outcome with the mean value of 49.3 (45.4–53.3). Most of the patients (56%, n = 31) used 2 crutches while walking, 23% (n = 13) - a cane or a crutch, and 11% (n = 6) – a walker. In 73% of cases (n = 40), the load-bearing capacity of the operated limb was preserved. In 27% of cases (n = 15) the limb was non-supporting, including 10 patients with severe pain syndrome under the load. At the same time, the pain syndrome was absent in the rest of the patients. The mean VAS score was 2.77 (2.3–3.12). Despite the insufficient function of the operated limb, 83.6% of patients noted a satisfactory result with the mean Instrument for measurement of health-related quality of life* score of 57.8 (52.1–63.4).
Conclusions
RHA with m. vastus lateralis flap plasty is a technically complex operation that in most cases leads to the elimination of chronic recurrent PJI. Apparently, the improvement of functional capabilities can be ensured by the use of revision arthroplasty or external fixation in order to form a supporting «new joint» (neoarthrosis).
* EQ5D
