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The direct anterior approach: treating periprosthetic joint infection of the hip using two-stage revision arthroplasty.

Abstract：

BACKGROUND:Either one- or two-stage revision arthroplasties can be used for the treatment of chronic periprosthetic joint infection (PJI) after total hip arthroplasty (THA). We report our results following two-stage revision surgery performed through the direct anterior approach (DAA) interval using a custom-made articulating spacer. METHODS:Between 2009 and 2014, 49 patients (49 consecutive procedures) had surgery through either a DAA or extended DAA approach. Each patient received perioperative intravenous administration of antibiotics. A custom-made spacer was implanted after explanting cup and stem and following extensive debridement. Broad-spectrum antibiotics were administered during the immediate perioperative period and then adjusted according to the infecting organism. Complication rates and eradication rates were observed. WOMAC patient assessments were administered preoperatively and one-year postoperatively. RESULTS:Of the 49 study patients, five had a recurrence of the infection after the second-stage revision, five had a proximal periprosthetic fracture during the first stage procedure and one patient had a transient femoral nerve palsy that resolved fully within the first postoperative year. 30 different microorganisms were identified on intraoperative specimens. The average time between first and second stage procedure was 65.7 days (range 21-132 days). Eradication of infection was defined as healed wound without fistula, no drainage, no recurrence of the infection, no subsequent surgical intervention for persistent or perioperative infection after second stage revision and no long-term (> 6 months) antimicrobial suppression therapy. Eradication rate of infection in our study was 89.8%. Postoperative WOMAC scores improved significantly CONCLUSION: The preliminary clinical results for the custom-made spacer technique implanted through the DAA are promising. Therefore, we believe the DAA can be used safely as a standard operative approach for two-stage revision procedures.

journal_name

Arch Orthop Trauma Surg

journal_title

Archives of orthopaedic and trauma surgery

authors

Thaler M,Lechner R,Dammerer D,Leitner H,Khosravi I,Nogler M

doi

10.1007/s00402-019-03317-1

subject

Has Abstract

pub_date

2020-02-01 00:00:00

pages

255-262

issue

eissn

0936-8051

issn

1434-3916

pii

10.1007/s00402-019-03317-1

journal_volume

140

pub_type

杂志文章

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The direct anterior approach: treating periprosthetic joint infection of the hip using two-stage revision arthroplasty.