One-stage revision hip arthroplasty for infection using primary cementless stems as first-line implants: About 35 cases

Abstract

Introduction: During infected total hip arthroplasty revisions (THAR), the need for systematic antibiotic cementation remains undefined.

Hypothesis: Implantation of a primary cementless stem as first-line implant in 1-stage septic THAR provides results as good as those from a stem cemented with antibiotics in terms of infection resolution.

Materials and methods: We retrospectively examined 35 patients operated on for septic THAR with Avenir® cementless stem placement - between 2008 and 2018 at Besançon University Hospital - with a minimum follow-up of 2 years to define healing in the absence of infectious recurrence. Clinical outcomes were assessed using the Harris, Oxford, and Merle D'Aubigné scores. Osseointegration was analyzed by the Engh radiographic score.

Results: The median follow-up was 5±2.6 years (2-11). The infection was cured in 32 of 35 (91.4%) patients. The median scores of the following were: Harris 77/100, Oxford 47.5/60 and Merle d'Aubigné 15/18. Of 32 femoral stems, 31 (96.8%) had radiographically stable osseointegration. Age greater than 80 years was a risk factor for failure to cure the infection during septic THAR.

Discussion: A primary cementless stem as first-line implant plays a role in 1-stage septic THAR. It confers good results in terms of infection resolution and stem integration in the setting of loss of femoral bone substances rated Paprosky 1.

Level of evidence: IV; retrospective case series.

Keywords: Cementless; Hip replacement; One-stage revision hip arthroplasty; Prosthesis-related infections; Total Hip Arthroplasty.