Revision of infected total hip prosthesis by explantation reimplantation with noncemented prosthesis. 57 case reports

Purpose of the study 57 cases of infected total hip prosthesis treated by r emoval of the implant and implantation of noncemented prosthesis, were stud ied to evaluate functional and sepsis results. Material and methods 57 patients treated by reimplantation of an uncemented total hip prosthesis after removal of the infected prosthesis were observe d. 16 patients underwent a single-stage exchange, 41 a two-stage reimplanta tion. 46 cases were analysed for infectional findings (clinical, radiologic al and biological assessment) and only 34 cases for functional evaluation ( PMA scale, Harris score) with a mean follow-up of 6,6 years. The antibiotic therapy was adapted to each patient but generally, the treatment was prolo nged. Results At follow-up time (which might be too short in time), only 2 patien ts had a reccurence of infection. One had a single-stage exchange (reoperat ed by two stage exchange with a good final result at 6 years follow-up), th e other a two-stage exchange. In both cases we found that postoperative ant ibiotic therapy was inadequate. Functional results were better with PMA sca le (23 good results of 34) than with Harris score (14 excellent or good res ults only). 5 patients were reoperated for mechanical implant failure. Discussion Since 1991, we adopted a standardized procedure to treat chronic infected total hip prosthesis including: routine preoperative aspiration o f symptomatic prosthesis; removal of the implant and around debridement fol lowed at a later date (6 weeks) by reimplatation using noncemented implants (hydroxyapatite coated implant). Postoperative antibiotic therapy has to b e massive (parenteral bitherapy for at least 21 days after each operative s tage) and has to last 6 months after reimplantation. This procedure seems r eliable and corroborate the validity of two-stage treatment. The using of u ncemented implants allows a good bone reconstruction and does not seem to i ncrease the risk of septic recurrence. Conclusion It is quite difficult to find a hard and fast rule in infected p rosthesis treatment, because many factors can influence results. The propos ed procedure seems reliable, even if antibiotherapy is long and hard, but r equires a strong collaboration between bacteriologist infectiologist and su rgeon.