Authors: Romanò CL, Romanò D, Logoluso N, Meani E; MILAN - ITALY
Title: Aseptic versus Septic Total Hip Arthroplasty Revision: Comparing the Results
Purpose: Our purpose was to compare the medium term results of infected versus non-infected total hip arthroplasty revision.
Methods: We prospectively evaluated the clinical and radiological outcomes of two series of patients that underwent one stage revision for aseptic loosening (Group A) or two-stage revision for septic total hip prosthesis (Group S). 40 consecutive patients were enrolled in each group. The patients were matched for sex, age and bone loss. There were 20 Type B hosts, according to Cierny-Mader classification in Group S, compared to 8 patients in Group A. In both groups revision was performed with an uncemented modular revision hip prosthesis. In Group S the two-stage revision was performed by using an antibiotic-loaded, preformed cement spacer (Spacer G - InterSpace Hip, Fig. 1). The second stage procedure was undertaken after a mean of 10 weeks (9-16 weeks). The average follow-up was 4 years (2-6 years).
Results: There was no difference in infection complication rate, with one case in each group. There was one aseptic loosening in Group S and none in Group A. The average Harris Hip Score increased from 19.1 to 74.0 in Group A versus 15.0 to 71.2 in Group S (P > 0.05). The average leg length discrepancy was 1.3 cm in Group A and 1.5 cm in Group S (P > 0.05). Patient reported quality of life outcomes (SF-12 and WOMAC questionnaires) did not show significant differences. Overall costs for hospital stay of two-stage procedure for infected cases were 2.2 times greater than those for aseptic cases.
Discuassion and Conclusion: Two-stage revision for infected hip prostheses, using a preformed antibiotic-loaded cement spacer and uncemented revision prosthesis, offers a success rate equivalent to non-infected revisions, at higher costs.