THE USE OF POROUS PROSTHESES IN DELAYED RECONSTRUCTION OF TOTAL HIP REPLACEMENTS THAT HAVE FAILED BECAUSE OF INFECTION

Between March 1984 and March 1989, thirty-four patients who had an inf ection at the site of a cemented total hip prosthesis were managed wit h resection arthroplasty and delayed implantation of a porous total hi p prosthesis without cement. The interval from the time of the resecti on arthroplasty to the implantation of another prosthesis averaged eig ht months (range, three to nineteen months). At an average of forty-se ven months (range, twenty-four to seventy-two months) after the reimpl antation, six patients (18 per cent) had recurrence of the infection. Patients who had rheumatoid arthritis were at significantly higher ris k for the development of a recurrent infection (p < 0.01). Of the twen ty-eight patients who did not have a recurrent infection, six had defi nite radiographic evidence of loosening of the femoral component at th e latest follow-up evaluation. For twenty-five of the twenty-eight pat ients, sufficient data were available for calculation of the Mayo Clin ic hip score; only fourteen (56 per cent) of these patients had a sati sfactory functional outcome. The high (68 per cent) rate of complicati ons and the long-term durability of the prosthesis in these patients r emain a concern. The fact that 18 per cent of the patients had a recur rent infection suggests that avoidance of the use of bone cement does not improve the rate of resolution of infection after a delayed revisi on operation in patients who have an infection following a total hip a rthroplasty.