Background: This study sought to compare the results of two-stage revision total hip arthroplasty (THA) for periprosthetic infection (PJI) in patients with and without the use of an extended trochanteric osteotomy (ETO) for removal of a well-fixed femoral stem or cement. Methods: Thirty-two patients who had undergone an ETO as part of a two-stage revision without spacer placement were matched 1:2 with a cohort of sixty-four patients of the same sex and age who had stem removal without any osteotomy. Clinical outcomes including interim revision, reinfection and aseptic failure rates were evaluated. Modified Harris hip scores (mHHS) were calculated. Minimum follow-up was two years. Results: Patients undergoing ETO had a significantly lower rate of interim re-debridement compared to non-ETO patients (0% vs. 14.1%, p = 0.026). Reinfection following reimplantation was similar in both groups (12.5% in ETO patients vs. 9.4% in non-ETO patients, p = 0.365). Revision for aseptic reason was necessary in 12.5% in the ETO group and 14.1% in the non-ETO group (p = 0.833). Periprosthetic femoral fractures were seen in three patients (3.1%), of which all occurred in non-ETO patients. Dislocation was the most common complication, which was equally distributed in both groups (12.5%). The mean mHHS was 37.7 in the ETO group and 37.3 in the non-ETO group, and these scores improved significantly in both groups following reimplantation (p < 0.01). Conclusion: ETO without the use of spacer is a safe and effective method to manage patients with well-fixed femoral stems and for thorough cement removal in two-stage revision THA for PJI. While it might reduce the rate of repeated debridement in the interim period, the use of ETO appears to lead to similar reinfection rates following reimplantation.
Background: Patients undergoing periacetabular osteotomy (PAO) for symptomatic developmental dysplasia of the hip are usually young and active with high functional demands. Those who participate in sports seek surgical therapy to resume or maintain sports activities. There is little evidence regarding the postoperative level of activity and the extent to which sports activity changes after PAO both qualitatively and quantitatively. Purpose: The aim of this study was to determine the change in activity level as measured using the University of California Los Angeles (UCLA) activity score and the changes in qualitative and quantitative sports activity. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective analysis of prospectively collected data of 123 hips in 111 patients who underwent PAO for developmental dysplasia of the hip between January 2015 and June 2017. UCLA activity score, International Hip Outcome Tool 12, and Subjective Hip Value, as well as practiced sports, frequency and duration of sports activity, and time to return to sports, were assessed. Eventual changes in practiced sports and reasons for those changes were recorded. Results: Of the participating patients, 85% were female and 15% were male. The mean patient age at the time of surgery was 27.7 ± 7.3 years. Mean follow-up was 63 ± 10 months. UCLA score (5.08 ± 2.44 vs 6.95 ± 1.74; P < .001), International Hip Outcome Tool 12 (41.4 ± 22.2 vs 72.6 ± 22.9; P < .001), and Subjective Hip Value (42.8 ± 24.3 vs 80.4 ± 17.8; P < .001) increased significantly from pre- to postoperatively. Significantly more patients participated in low-impact sports postoperatively (31.7% vs 52%; P = .001). Participation in high-impact sports decreased (42.3% vs 36.6%; P = .361). The overall sports activity rate increased significantly (78.8% vs 90.8%; P = .008). Quantitatively, sports frequency in times per week ( P < .001) as well as length of exercise per time ( P = .007) increased significantly. A total of 52 patients (42%) changed sports activities postoperatively. Of these, 35 (28.4%) reported having stopped previously practiced sports after surgery, while 17 (13.8%) reported having started new sports. Reasons for starting and stopping certain sports varied and included hip- and non–hip related ones. In only 2 cases was physician’s advice given as a reason for changing the sport. Conclusion: Patients can improve their sports activity both qualitatively and quantitatively after PAO. However, a relevant proportion of patients adjusts their sports activities for a variety of hip-related and non–hip related reasons.
Background: High rates of spacer-related complications in two-stage exchange total hip arthroplasty (THA) have been reported. Patients with advanced bone defects and abductor deficiency may benefit from a nonspacer two-stage revision. This study reports on the clinical course of a contemporary twostage exchange for periprosthetic hip infection without spacer insertion. Methods: We reviewed 141 infected THAs with extensive bone loss or abductor damage who underwent two-stage exchange without spacer placement. The mean duration from resection arthroplasty to reimplantation was 9 weeks (2-29). Clinical outcomes included interim revision, reinfection, and aseptic revision rates. Restoration of leg-length and offset was assessed radiographically. Modified Harris hip scores were calculated. Mean follow-up was 5 years (3-7). Treatment success was defined using the modified Delphi consensus criteria. Results: Thirty-four patients (24%) had treatment failure, including 13 reinfections, 16 interim redebridements for persistent infection, 2 antibiotic suppressive therapies, and 3 prosthetic joint infection erelated deaths. Aseptic rerevision after reimplantation was necessary in 14 patients (10%). Dislocation accounted for most aseptic complications, with 20 dislocations occurring in 15 patients (11%). Leglength and offset were restored to preoperative measures. Mean modified Harris hip scores significantly improved from 35 points to 67 points. Conclusion: A nonspacer two-stage exchange is a viable option for managing chronically infected THA with severe bone loss or abductor deficiency, showing comparable rates of interim revision and recurrence of infection. Cementless reimplantation demonstrates good midterm survivorship with comparable functional outcomes and leg-length restoration. However, dislocation continues to be a major concern.
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