Authors: Azzam K, Davis E, Purtill J, Austin M, Parvizi J
Title: Two Stage Exchange Arthroplasty for Infected Total Hip Arthroplasty: Are Results as Good as They Seem?
Institution: Rothman Institute, Philadelphia, PA
Purpose: We hypothesized that reported outcome for two?stage exchange arthroplasty is worse than what is currently perceived and that the success of this procedure in the future may further be compromised due to the increase incidence of PPI caused by MRSA.
Methods: A computerized literature search was conducted to identify all citations, from 1990 to 2008,concerning two?stage resection arthroplasty for periprosthetic hip infections. All articles were included. The details of the reported data were extracted and statistical analysis of relevant variables was carried out.
Results: 28 published articles that included a total of 966 infected total hip arthroplasties treated with a two?stage protocol were included in the meta?analysis. Two?stage exchange arthroplasty was thought to be successful and eradicated infection in 89% (range, 74 to 97%) of hips. However, the prevalence of mechanical complications was 7%. Most reports did not report the attrition rate or the number of patients who were on suppressive antibiotic therapy. Only 15% of infections in these series were MRSA. The follow?up for most reports was short at a mean of 4 years (range, 1 to 9 years). The reoperation rate in the series was 14%. Thus, if reoperation and early mechanical failure is taken into account, the success rate of two?stage arthroplasty drops to 68%.
Discussion and Conclusion: Despite all the recent advances in diagnosis and management of periprosthetic infection, the outcome of the most commonly implemented surgical protocol for treatment remains highly variable and generally unpredictable. It appears that the success rate of two?stage exchange arthroplasty is much less optimistic if important variables such as attrition rate, related mechanical failures, and reoperations are taken into account.