Ikebe Satoshi, Sonohata Motoki, Kitajima Masaru, Kawano Shunsuke, Mawatari Masaaki
Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan.
Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan.
J Orthop Sci. 2018 May;23(3):532-537. doi: 10.1016/j.jos.2018.01.014. Epub 2018 Feb 17.
Complications associated with re-implantation of total hip arthroplasty (THA) after resection arthroplasty for the treatment of primary septic hip arthritis or infected THA and bipolar hemiarthroplasty (BHA) are not well-documented. Furthermore, no comparison has been made between septic arthritis (SA) and infected THA and BHA. We divided subjects into two groups for evaluation: a SA group and an infected THA or BHA group.
Nineteen hips in 19 patients (12 in the SA group, 7 in the infected THA or BHA group) with an average of 77 months of follow-up from the time of re-implantation THA were retrospectively evaluated.
The average Japanese Orthopaedic Association hip score improved from 50 points (range, 30 to 73 points) preoperatively to 80 points (range: 64 to 96 points) at the time of the final follow-up (p < 0.01). Intra- and postoperative complications occurred in 11 cases, including intraoperative fracture in 1 hip, deep infection in 6 hips, dislocation in 7 hips, and septic loosening of acetabular component in 2 hips. Following re-implantation, further surgical revision was required in four cases. Two revisions were performed for recurrent infection: one patient had recurrent dislocation of one hip, and one patient had recurrent infection and dislocation. The number of hips with relapsed infection in the infected THA or BHA group (5 hips) was significantly higher than that in the SA group (1 hip) (p < 0.05).
Re-implantation after septic hip arthritis or infected THA or BHA was an effective treatment for improving the activity of daily life, especially the gait function. Furthermore, 94.7% of patients were free of infection at the latest follow-up. However, the rate of recurrence of infection was 31.6%, and re-implantation after resection arthroplasty following infected THA or BHA led to a lower rate of infection control than that after primary SA.
在治疗原发性化脓性髋关节炎或感染性全髋关节置换术（THA）及双极半髋关节置换术（BHA）后进行全髋关节置换术再植入相关的并发症尚未得到充分记录。此外，尚未对化脓性关节炎（SA）与感染性THA及BHA进行比较。我们将受试者分为两组进行评估：SA组和感染性THA或BHA组。
回顾性评估19例患者的19髋（SA组12髋，感染性THA或BHA组7髋），自再植入THA时起平均随访77个月。
日本骨科协会髋关节平均评分从术前的50分（范围30至73分）提高到末次随访时的80分（范围64至96分）（p < 0.01）。术中和术后并发症发生11例，包括1髋术中骨折、6髋深部感染、7髋脱位以及2髋髋臼组件感染性松动。再植入后，有4例需要进一步手术翻修。2例翻修是因为复发性感染：1例患者1髋复发性脱位，1例患者复发性感染并脱位。感染性THA或BHA组感染复发的髋数（5髋）显著高于SA组（1髋）（p < 0.05）。
化脓性髋关节炎或感染性THA或BHA后再植入是改善日常生活活动尤其是步态功能的有效治疗方法。此外，在最新随访时94.7%的患者无感染。然而，感染复发率为31.6%，感染性THA或BHA后切除关节成形术后再植入导致感染控制率低于原发性SA后再植入。
