Cementless One-Stage Revision in Chronic Periprosthetic Hip Joint Infection. Ninety-One Percent Infection Free Survival in 56 Patients at Minimum 2-Year Follow-Up

Cementless 1-stage revision in chronic periprosthetic hip joint infections is limited evaluated. The purpose of this study was to evaluate a specific treatment protocol in this patient group. The study was performed as a multicenter, proof-of-concept, observational study with prospective data collec...

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Bibliographic Details
Published in:The Journal of arthroplasty 2018-04, Vol.33 (4), p.1160-1165.e1
Main Authors: Lange, Jeppe, Troelsen, Anders, Solgaard, Søren, Otte, Kristian S., Jensen, Niels K., Søballe, Kjeld, Zawadski, Andre, Kjersgaard, Anne Grete, Heine, Christian, Riis, Jess, Stahl Otte, Kristian, Lamm, Martin, Dehghani, Mohammad Hossein, Krarup, Niels, Poulsen, Ninna Rysholdt, Kjærsgaard-Andersen, Per, Nielsen, Poul Torben, Mikkelsen, Søren Søndergaard, Prynø, Thomas, Vester, Thomas, Ørsnes, Thue
Format: Article
Language:English
Subjects:
Adult
Aged
arthroplasty
Arthroplasty, Replacement, Hip - adverse effects
assessment
Bone Cements
Cementation
Chronic Disease
Clinical Protocols
Female
Follow-Up Studies
Hip Joint - microbiology
Hip Joint - surgery
Hip Prosthesis - adverse effects
Hip Prosthesis - microbiology
Humans
infection
Middle Aged
Prosthesis Failure
Prosthesis-Related Infections - drug therapy
Prosthesis-Related Infections - microbiology
Prosthesis-Related Infections - surgery
Reoperation
surgery
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Summary:Cementless 1-stage revision in chronic periprosthetic hip joint infections is limited evaluated. The purpose of this study was to evaluate a specific treatment protocol in this patient group. The study was performed as a multicenter, proof-of-concept, observational study with prospective data collection. Patients were treated with a cementless 1-stage revision according to the CORIHA protocol between 2009 and 2014. Fifty-six patients, McPherson type III-A/B-1/2, were enrolled with a mean follow-up time from the CORIHA procedure of 4 years (minimum of 2 years). The primary outcome was re-revision performed due to infection and was evaluated by competing risk analysis, with death and aseptic revision as competing events. All-cause mortality was evaluated by Kaplan-Meier survival analysis. Oxford Hip Score (OHS) was used as disease-specific patient-reported outcome measure. The cumulative incidence of re-revision due to infection was 8.9% (confidence interval [CI] 3.2%-18.1%). The 1-year and 5-year survival incidence was 96% (CI 86%-99%) and 89% (CI 75%-95%). OHS at baseline was 19.9 (CI 17.3-22.6) and at 24-month follow-up 35.1 (CI 31.7-38.5). The mean change in OHS from baseline to 24-month follow-up was 11.8 points (CI 7.3; 16.3). Three patients had aseptic revision performed: two suffered periprosthetic fractures and one had stem subsidence. Failure analysis of the 5 reinfections did not detect a clear pattern as to the cause of failure. We found that cementless 1-stage revision in chronic periprosthetic hip joint infections has low reinfection rates in selected patients and may be applicable as a first-line treatment.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2017.11.024