RESEARCH ARTICLE


Revision in Cemented and Cementless Infected Hip Arthroplasty



Paolo Cherubino, Marco Puricelli , Fabio D’Angelo*
Department of Biotechnologies and Life Sciences, Section of Orthopedics and Traumatology, University of Insubria, Varese, Italy


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© Cherubino et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Biotechnologies and Life Sciences, Section of Orthopedics and Traumatology, University of Insubria, Ospedale di Circolo - Viale Borri, 57 - 21100 Varese, Italy; Tel: 39-0332-278824; Fax: 39-0332-278825; E-mail: fabio.dangelo@uninsubria.it


Abstract

Infection is a frequent cause of failure after joint replacement surgery. The infection rate after total hip arthroplasty (THA) has been reduced to 1-2% in the last years. However, it still represents a challenging problem for the orthopedic surgeon.

Difficulty of therapeutic approach, and poor functional outcomes together with length of treatment and overall cost are the main burden of this issue. Even the diagnosis of an infected hip could be challenging although it is the first step of an accurate treatment. At the end, many cases require removing the implants. Afterwards, the treatment strategy varies according to authors with three different procedures: no re-implantation, immediate placement of new implants or a two-stage surgery re-implantation.

Based on the most recently systematic review there is no suggestion that one- or two-stage revision methods have different re-infection outcomes.

The two-stage implant-exchange protocol remains the gold standard. It is considered as the most efficacious clinical approach for the treatment of periprosthetic infection, especially in patients with sinus tracts, swelling, extended abscess formation in depth and infection of Methicillin Resistant Staphylococcus Aureus (MRSA), and other multidrug-resistant bacteria as reported in recent consensus documents.

Keywords: Hip arthroplasty, infection, two-stage revision, spacer..