Li Peng, Hou Ming, Zhu Zhi-Qi, Shi Zhan-Jun
Department of Orthopaedic Surgery, Longgang District People's Hospital of Shenzhen, Shenzhen, China.
Orthop Surg. 2015 Feb;7(1):37-42. doi: 10.1111/os.12159.
To investigate cementless revision for postoperative infection after total hip arthroplasty (THA).
From November 1997 to December 2009, 10 patients (10 hips; four males, six females) of mean age 58 years (36-73 years) with infection after THA were treated. Six of the 10 hips underwent revision total hip arthroplasty, two only received new acetabular components and two underwent stem revision. One-stage revision was performed in six cases and two-stage revision in four. Consecutive radiographs were compared to evaluate component conditions. Harris hip scores were determined before surgery and at final follow-up. Erythrocyte sedimentation rate and C-reactive protein were assessed.
All patients were followed up for a mean duration of 8.6 years (6.5-15.6 years). The mean Harris hip score improved from 35 (18-63) points preoperatively to 89 (60-99) points at final follow-up. No re-infection occurred. Femoral component exsertion was occurred in one asymptomatic patient. Hip joint pain resolved in seven cases; three patients had mild pain when walking long distances. At final follow-up, six patients still had slight limps. Heterotopic ossification developed in two hips. Mean polyethylene liner wear was 0.08 mm per year at final follow-up. Deep vein phlebothrombosis and nerve injury did not occur.
One- or two-stage revisions using cementless prosthesis can produce satisfactory clinical outcomes in patients with infection after THA. Whether the original prosthesis can be partially retained when attached tightly to the femur or acetabular bone needs further investigation.
探讨全髋关节置换术（THA）术后感染的非骨水泥型翻修术。
1997年11月至2009年12月，对10例平均年龄58岁（36 - 73岁）的THA术后感染患者（10髋；4例男性，6例女性）进行治疗。10髋中的6髋接受了翻修全髋关节置换术，2髋仅更换了新的髋臼组件，2髋进行了柄部翻修。6例患者进行了一期翻修，4例进行了二期翻修。对比连续的X线片以评估假体情况。在手术前及末次随访时测定Harris髋关节评分。评估红细胞沉降率和C反应蛋白。
所有患者平均随访8.6年（6.5 - 15.6年）。Harris髋关节评分平均从术前的35分（18 - 63分）提高到末次随访时的89分（60 - 99分）。未发生再次感染。1例无症状患者出现股骨假体穿出。7例患者髋关节疼痛缓解；3例患者长距离行走时有轻度疼痛。在末次随访时，6例患者仍有轻微跛行。2髋出现异位骨化。末次随访时聚乙烯内衬平均每年磨损0.08 mm。未发生深静脉血栓形成和神经损伤。
使用非骨水泥型假体进行一期或二期翻修，可使THA术后感染患者获得满意的临床疗效。当原假体与股骨或髋臼骨紧密附着时能否部分保留，需进一步研究。
