[Resection Arthroplasty Using a Vastus Lateralis Muscle Flap in the treatment of patients with recurrent form of the hip prosthetic joint infection].

OBJECTIVE

To evaluate the efficacy of chronic recurrent hip periprosthetic joint infection (PJI) eradication after resection arthroplasty with non-free transplantation of vastus lateralis muscle flap of the thigh.

MATERIAL AND METHODS

There were 38 patients with chronic recurrent hip PJI who underwent resection arthroplasty with non-free transplantation of vastus lateralis muscle flap of the thigh in 2005-2016. The groups were compiled considering the absence or presence of recurrent infection in early postoperative period. Infection duration, number of operations, incidence of recurrent PJI, type of pathogen, laboratory parameters, bone defect size and presence of PJI remission within at least 2 years were investigated.

RESULTS

Uneventful early postoperative period after resection arthroplasty with non-free transplantation of vastus lateralis muscle flap was noted in 81.6% of cases (n=31, group 1). Postoperative wound revision was required in 18.4% of cases (n=7, group 2). Stable remission of infection within 2-8 years (Me - 4 years) was achieved in 36 (94.7%) patients. Relative risk of recurrent PJI increased by more than 4 times (RR 4,364, 95% CI 0,581-32,787) in cases of polymicrobial infection involving Gram-negative bacteria and decreased in cases of monomicrobial infection (RR 0,256, 95% CI 0,034-1,916). Significantly longer duration of surgery and more pronounced laboratory changes were revealed in group 2.

CONCLUSION

High efficacy of resection arthroplasty with non-free transplantation of vastus lateralis muscle flap of the thigh was established in patients with chronic recurrent hip PJI. This procedure might be considered as a stage treatment with the possibility for revision arthroplasty in case of failed initial debridement surgery due to PJI pathogens that are difficult for eradication.