Total hip arthroplasty for destructive septic arthritis of the hip using a two-stage protocol without spacer placement

Abstract

Introduction: The optimal treatment of patients with a degenerative joint disease secondary to an active or chronic septic arthritis of the hip is unclear. The aim of the present study was to report on our experience with two-stage total hip arthroplasty (THA) using a contemporary treatment protocol without spacer insertion.

Materials and methods: Our prospective institutional database was used to identify all patients with degenerative septic arthritis treated with a non-spacer two-stage protocol between 2011 and 2017. Clinical outcomes included interim revision, periprosthetic infection (PJI) and aseptic revision rates. Restoration of leg-length and offset were assessed radiographically. Modified Harris hip score (mHHS) were obtained. Treatment success was defined using the modified Delphi consensus criteria. Mean follow-up was 62 months (13-110).

Results: A total of 33 patients with a mean age of 60 years (13-85) were included. 55% of the cohort was male and average Charlson Comorbidity Index (CCI) was 3.7 (0-12). 21 patients (64%) had an active/acute infection and 12 patients (36%) were treated for chronic/quiescent septic arthritis. Overall, 11 patients (33%) had treatment failure, including 5 patients who failed to undergo THA, 2 interim re-debridement for persistent infection, and 4 patients who developed PJI after an average of 7 months (0.3-13) following THA. The most common identified pathogen was Staphylococcus aureus (42.4%). No aseptic revision was recorded following THA. Leg-length and offset were successfully restored. Mean mHHS improved from 35.2 points to 73.4 points.

Conclusion: Two-stage THA without spacer placement is a viable treatment option for destructive septic arthritis of the hip, demonstrating comparable rates of infection control and functional outcome. However, definitive resection arthroplasty is not uncommon in these often critically ill patients.

Keywords: Hip; Periprosthetic infection; Resection arthroplasty; Septic arthritis; Spacer; Total hip arthroplasty; Two-stage.

Fig. 1

Radiographs of a 79-old female patient with destructive septic arthritis of the left hip. a Anteroposterior view 5 months before clinical presentation. b Preoperative radiograph prior to two-stage total hip arthroplasty (THA). c Postoperative radiograph following resection arthroplasty without spacer insertion. d Postoperative radiograph showing the definitive THA after an interim period of 4 weeks using a highly porous acetabular shell and an extensively porous-coated femoral stem. Leg-length was successfully restored. At latest follow-up, the patient showed no signs of PJI and had a modified Harris hip score of 63 points

Fig. 2

Flowchart outlining the treatment outcome of all patients included in the study