Abstract
Infection remains a serious complication of total hip replacement (THR). Management options have been developed to improve clearance of infection while maintaining joint function during treatment and improve outcome at reimplantation. The gold standard in management is generally considered to be implant removal and thorough debridement with antibiotic therapy delivered systemically and locally with impregnated spacers. However, some surgeons still prefer to use Girdlestone resection arthroplasty, thus not leaving any foreign body in situ.
The aim of this study was to compare infection clearance rates, radiographic and functional outcomes after two-stage revision of total hip arthroplasty with (1) gentamicin-loaded bone cement spacer or (2) Girdlestone resection arthroplasty as the first stage of treatment.
We retrospectively reviewed data of 48 patients (20 females, 28 males) with implanted spacers and 53 patients (21 females, 32 males) treated with resection arthroplasty at tertiary care university hospital in the years 2008–2012. Minimum follow-up was three years (range, 3–7 years). Treatment choice was at the operating surgeons's discretion.
In the spacer group, mean age at the time of first stage was 62 years (range 24–79 years), time from primary replacement 14 months, and the time from the first to the second stage of the revision 7 months. At latest, minimum 3-year follow-up, two were still ambulating with a spacer in situ, and five were re-revised with another spacer before the reimplantation of the THR.
In the resection arthroplasty group, mean age at the time of first stage was 64 years (range, 37–87 years), time from primary replacement 13 months, and the time from the first to the second stage of revision − 10 months. At the latest follow-up, four patients were ambulating with resection arthroplasty, one did not clear his infection and one died of unrelated causes.
The cure ratio appeared to be the same within both groups (Fisher exact test, p=0.08). Patients with spacers achieved better functional results, used less supports for ambulation and had less leg length discrepancy after the second stage of revision. In the light of those results, we cannot recommend for the use of resection arthroplasty in the treatment of the infected THR.
