A multidisciplinary team approach to two-stage revision for the infected hip replacement

Abstract

We report the five year outcomes of a two-stage approach for infected total hip replacement. This is a single-surgeon experience at a tertiary centre where the more straightforward cases are treated using single-stage exchange. This study highlights the vital role of the multidisciplinary team in managing these cases. A total of 125 patients (51 male, 74 female) with a mean age of 68 years (42 to 78) were reviewed prospectively. Functional status was assessed using the Harris hip score (HHS). The mean HHS improved from 38 (6 to 78.5) pre-operatively to 81.2 (33 to 98) post-operatively. Staphylococcus species were isolated in 85 patients (68%). The rate of control of infection was 96% at five years. In all, 19 patients died during the period of the study. This represented a one year mortality of 0.8% and an overall mortality of 15.2% at five years. No patients were lost to follow-up. We report excellent control of infection in a series of complex patients and infections using a two-stage revision protocol supported by a multidisciplinary approach. The reason for the high rate of mortality in these patients is not known.

Two-Stage Cementless Revision Total Hip Arthroplasty for Infected Primary Hip Arthroplasties

“…Different studies demonstrated significant increase in the Harris hip score following twostage revision THA [19,20,29]. Ibrahim et al reported that the Harris hip score was improved from 38 to 81.2 points following two-stage revision [20]. On the other hand, according to the results of their study evaluating two-stage revision of the hip arthroplasties infected by Methicillinresistant species, Leung et al mentioned that the functional scores for their patients were lower than those reported in the literature [27].…”

“…It has been reported that one-stage cementless revision THA in selected patients who were non-immunocompromised, without previous hip infection, without chronic consumptive disease, without any sign of acute systemic infection, without a discharging sinus, and with an adequate soft tissue and bone stock revealed high rates of success [2,19]. Although studies evaluating one-stage revision arthroplasty with comparable results have been published in the literature, many authors have recommended two-stage revision surgery as the first choice in the management of late onset prosthetic joint infection [14,15,20,21]. According to Kelm et al, the benefit and superiority of two-stage revision are immediate treatment of the source of infection by reaching high antibiotic levels locally [22].…”

“…Harris hip score is one of the most commonly used instruments for the functional status evaluation following hip joint procedures. Different studies demonstrated significant increase in the Harris hip score following twostage revision THA [19,20,29]. Ibrahim et al reported that the Harris hip score was improved from 38 to 81.2 points following two-stage revision [20].…”

Distribution characteristics of Staphylococcus spp. in different phases of periprosthetic joint infection: A review

“…Among the 20 studies, six studies (1,8,33,38–40) reported knee cases, five (9,32,41–43) reported hip cases and nine (2,6,12,13,19,20,27,28,44) reported knee and hip cases. Of the nine studies, four articles (6,12,28,44) were divided into two categories of knee and hip cases on the basis of the type of staphylococci, whereas the other five studies (2,13,19,20,27) were not.…”

Definition of Periprosthetic Hip and Knee Joint Infections and the Economic Burden

“…[25] reports the benefits of a MDT approach. The team responsible for the management of the 125 patients (51.2% undergoing their first revision, 16.8% second revision) with infected THA included microbiologists, infectious disease specialists, orthopaedic surgeons, radiologists, physiotherapists and physicians.…”