Effectiveness of total hip arthroplasty for hip infection sequelae_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Gensheng ^1,2 ,  LIU Ruiyu ¹ , WANG Kunzheng ¹ , LI Haitao ³ , TANG Yilun ¹ , BAI Chuanyi ¹ , DANG Xiaoqian ¹

1. Department of Orthopedics, the Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an Shaanxi, 710004, P.R.China;
2. Department of Orthopedics, Hanzhong Railway Central Hospital, Hanzhong Shaanxi, 723000, P.R.China;
3. Department of Orthopedics, Hanzhong People’s Hospital, Hanzhong Shaanxi, 723000, P.R.China;

Corresponding?author：

LIU Ruiyu, Email: liuryu@126.com

Keywords：

Total hip arthroplasty; hip infection; deformity of hip joint; function of joint

DOI：

10.7507/1002-1892.201807033

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ObjectiveTo evaluate hip function and reinfection of the patients with hip infection sequelae after total hip arthroplasty (THA) treatment.MethodsA clinical data of 31 patients (31 hips) with hip infection sequelae, who were treated with THA between June 2010 and May 2017, was retrospectively analyzed. There were 18 males and 13 females, with an average age of 46.1 years (range, 20-71 years). There were pyogenic infection in 17 cases, tuberculous infection in 9 cases, and unknown source of infection in 5 cases. The average time from infection to cure was 13.9 months (range, 6-25 months). The average time from cure to operation was 23.4 years (range, 6-58 years) for patients with confirmed source of infection. According to Kim classification, 12 cases were rated as typeⅠ, 9 as typeⅡ, and 10 as type Ⅲ. There were 21 cases of osteoarthritis after dysplasia, 7 cases of pathologic dislocation, and 3 cases of hip ankylosis. After operation, the infection was assessed by physical signs and laboratory tests; X-ray film of the hip was taken to assess the skeletal structure of the hip and infectious lesion; the length of the lower limb was measured, and the function of the hip joint was evaluated by Harris score.ResultsAll patients were followed up 10-63 months (mean, 34 months). The result of bacterial culture was negative. The incisions healed by first intention. The sciatic nerve stimulation occurred in 1 case and posterior dislocation of the joint occurred in 1 case after operation. There was no recurrence of infection and no aseptic loosening of the prosthesis. According to Harris score, the function of the hip was rated as excellent in 8 cases, good in 19 cases, and fair in 4 cases at last follow-up; and the excellent and good rate of hip joint function was 87%. X-ray films showed no patchy bone density reduction, spot hardening, or light areas. The length of affected limb was not fully equal with the unaffected limb in 5 cases, and the difference between two sides ranged from 0.4 to 1.3 cm (mean, 0.6 cm). At last follow-up, all patients had no obvious claudication or sensation of unequal length.ConclusionTHA can obtain satisfactory hip function and has low risk of infection recurrence for the patients with hip infection sequelae, who were assessed as the hip infection in a dormant state.

Citation： ZHANG Gensheng, LIU Ruiyu, WANG Kunzheng, LI Haitao, TANG Yilun, BAI Chuanyi, DANG Xiaoqian. Effectiveness of total hip arthroplasty for hip infection sequelae. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1495-1499. doi: 10.7507/1002-1892.201807033 Copy

1.	Craigen MA, Watters J, Hackett JS. The changing epidemiology of osteomyelitis in children. J Bone Joint Surg (Br), 1992, 74(4): 541-545.
2.	Nunn TR, Cheung WY, Rollinson PD. A prospective study of pyogenic sepsis of the hip in childhood. J Bone Joint Surg (Br), 2007, 89(1): 100-106.
3.	康鵬德, 裴福興, 王坤正. 感染后髖關節的初次人工關節置換. 中華骨科雜志, 2005, 25(7): 404-408.
4.	譚鋼, 羅磊, 楊靜, 等. 3664例全髖關節置換術相關危險因素分析. 中國矯形外科雜志, 2011, 19(17): 1431-1434.
5.	Park YS, Moon YW, Lim SJ, et al. Prognostic factors influencing the functional outcome of total hip arthroplasty for hip infection sequelae. J Arthroplasty, 2005, 20(5): 608-613.
6.	Dudkiewicz I, Salai M, Chechik A, et al. Total hip arthroplasty after childhood septic hip in patients younger than 25 years of age. J Pediatr Orthop, 2000, 20(5): 585-587.
7.	Kim YH, Oh SH, Kim JS. Total hip arthroplasty in adult patients who had childhood infection of the hip. J Bone J Surg (Am), 2003, 85(2): 198-204.
8.	Kim YH. Total arthroplasty of the hip after childhood sepsis. J Bone Joint Surg (Br), 1991, 73(5): 783-786.
9.	Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J Arthroplasty, 2003, 18(3 Suppl 1): 68-73.
10.	Gao X, He RX, Yan SG. Total hip arthroplasty for patients with osteoarthritis secondary to hip pyogenic infection. Chin Med J (Engl), 2010, 123(2): 156-159.
11.	Manzotti A, Rovetta L, Pullen C, et al. Treatment of the late sequelae of septic arthritis of the hip. Clin Orthop Relat Res, 2003, (410): 203-212.
12.	盧宏章, 朱天岳, 柴衛兵, 等. 感染后關節的初次人工關節置換術. 中華骨科雜志, 2004, 24(4): 203-206.
13.	Hampton BJ, Harris WH. Primary cementless acetabular components in hips with severe developmental dysplasia or total dislocation. A concise follow-up, at an average of sixteen years, of a previous report. J Bone Joint Surg (Am), 2006, 88(7): 1549-1552.
14.	張亮, 李玉軍, 郭曉忠, 等. 人工全髖關節置換術治療髖關節感染繼發骨關節炎的中期療效. 中國修復重建外科雜志, 2014, 28(2): 218-222.
15.	Farrell CM, Springer BD, Haidukewych GJ, et al. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg (Am), 2005, 87(12): 2619-2625.
16.	呂寧. 閉合復位空心釘內固定和人工全髖關節置換治療股骨頸骨折的臨床療效分析. 大連: 大連醫科大學, 2013.
17.	Hardinge K, Cleary J, Charnley J. Low-friction arthroplasty for healed septic and tuberculous arthritis. J Bone Joint Surg (Br), 1979, 61-B(2): 144-147.
18.	李滿江, 王智勇, 張志強. 血清降鈣素原在診斷關節置換術后早期感染的臨床意義. 中華骨與關節外科雜志, 2015, 8(6): 546-548.
19.	Greidanus NV, Masri BA, Garbuz DS, et al. Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty. A prospective evaluation. J Bone Joint Surg (Am), 2007, 89(7): 1409-1416.
20.	Nazem K, Motififard M, Yousefian M. Variations in ESR and CRP in total knee arthroplasty and total hip arthroplasty in Iranian patients from 2009 to 2011. Adv Biomed Res, 2016, 5: 148.

1. Craigen MA, Watters J, Hackett JS. The changing epidemiology of osteomyelitis in children. J Bone Joint Surg (Br), 1992, 74(4): 541-545.
2. Nunn TR, Cheung WY, Rollinson PD. A prospective study of pyogenic sepsis of the hip in childhood. J Bone Joint Surg (Br), 2007, 89(1): 100-106.
3. 康鵬德, 裴福興, 王坤正. 感染后髖關節的初次人工關節置換. 中華骨科雜志, 2005, 25(7): 404-408.
4. 譚鋼, 羅磊, 楊靜, 等. 3664例全髖關節置換術相關危險因素分析. 中國矯形外科雜志, 2011, 19(17): 1431-1434.
5. Park YS, Moon YW, Lim SJ, et al. Prognostic factors influencing the functional outcome of total hip arthroplasty for hip infection sequelae. J Arthroplasty, 2005, 20(5): 608-613.
6. Dudkiewicz I, Salai M, Chechik A, et al. Total hip arthroplasty after childhood septic hip in patients younger than 25 years of age. J Pediatr Orthop, 2000, 20(5): 585-587.
7. Kim YH, Oh SH, Kim JS. Total hip arthroplasty in adult patients who had childhood infection of the hip. J Bone J Surg (Am), 2003, 85(2): 198-204.
8. Kim YH. Total arthroplasty of the hip after childhood sepsis. J Bone Joint Surg (Br), 1991, 73(5): 783-786.
9. Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J Arthroplasty, 2003, 18(3 Suppl 1): 68-73.
10. Gao X, He RX, Yan SG. Total hip arthroplasty for patients with osteoarthritis secondary to hip pyogenic infection. Chin Med J (Engl), 2010, 123(2): 156-159.
11. Manzotti A, Rovetta L, Pullen C, et al. Treatment of the late sequelae of septic arthritis of the hip. Clin Orthop Relat Res, 2003, (410): 203-212.
12. 盧宏章, 朱天岳, 柴衛兵, 等. 感染后關節的初次人工關節置換術. 中華骨科雜志, 2004, 24(4): 203-206.
13. Hampton BJ, Harris WH. Primary cementless acetabular components in hips with severe developmental dysplasia or total dislocation. A concise follow-up, at an average of sixteen years, of a previous report. J Bone Joint Surg (Am), 2006, 88(7): 1549-1552.
14. 張亮, 李玉軍, 郭曉忠, 等. 人工全髖關節置換術治療髖關節感染繼發骨關節炎的中期療效. 中國修復重建外科雜志, 2014, 28(2): 218-222.
15. Farrell CM, Springer BD, Haidukewych GJ, et al. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg (Am), 2005, 87(12): 2619-2625.
16. 呂寧. 閉合復位空心釘內固定和人工全髖關節置換治療股骨頸骨折的臨床療效分析. 大連: 大連醫科大學, 2013.
17. Hardinge K, Cleary J, Charnley J. Low-friction arthroplasty for healed septic and tuberculous arthritis. J Bone Joint Surg (Br), 1979, 61-B(2): 144-147.
18. 李滿江, 王智勇, 張志強. 血清降鈣素原在診斷關節置換術后早期感染的臨床意義. 中華骨與關節外科雜志, 2015, 8(6): 546-548.
19. Greidanus NV, Masri BA, Garbuz DS, et al. Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty. A prospective evaluation. J Bone Joint Surg (Am), 2007, 89(7): 1409-1416.
20. Nazem K, Motififard M, Yousefian M. Variations in ESR and CRP in total knee arthroplasty and total hip arthroplasty in Iranian patients from 2009 to 2011. Adv Biomed Res, 2016, 5: 148.

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