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Two-stage Total Hip Arthroplasty: How Often Does It Control Methicillin-resistant Infection?

  • Symposium: Periprosthetic Joint Infection
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Methicillin-resistant hip infections are increasingly common. Reports of the surgical management of these patients using two-stage THA show variable control of infection, but all reports used static spacers.

Questions/purposes

We therefore determined (1) the rate of successful control of infection and (2) function in patients with methicillin-resistant infection treated with a two-stage THA using an articulated cement spacer during the first stage.

Methods

We retrospectively reviewed 50 patients who had a two-stage revision THA for methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis infection. Twelve patients died, leaving 38 for review. All eligible patients completed quality-of-life outcome questionnaires (WOMAC, SF-12, Oxford-12, UCLA activity score, hip and knee satisfaction score). Minimum followup was 24 months after the second stage (mean, 58 months; range, 24–123 months).

Results

Of the 38 patients, eight (21%) had recurrence of their infection requiring further revision surgery. Of the remaining 27 patients, the mean WOMAC was 62, mean Oxford-12 60, mean UCLA activity score 4.3, and mean hip and knee satisfaction score 66.

Conclusions

We found a treatment failure rate of 21% for patients with methicillin-resistant S. aureus or methicillin-resistant S. epidermidis infection. This is a higher rate than reported for two-stage THA for studies including patients infected with both nonresistant and resistant organisms. The functional scores for patients were also lower than those reported in the literature.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgment

We thank Dr Nelson V. Greidanus for contributing patients to this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Avenue, Vancouver, BC, V5Z 4E3, Canada

    Fay Leung MD, FRCSC, Donald S. Garbuz MD, MHSc, FRCSC, Bassam A. Masri MD, FRCSC & Clive P. Duncan MB, MSc, FRCSC

  2. Department of Orthopaedics, Hull Hospital, Gatineau, QC, Canada

    Corey J. Richards MD, MASc, FRCSC

Authors
  1. Fay Leung MD, FRCSC
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  2. Corey J. Richards MD, MASc, FRCSC
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  3. Donald S. Garbuz MD, MHSc, FRCSC
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  4. Bassam A. Masri MD, FRCSC
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  5. Clive P. Duncan MB, MSc, FRCSC
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Corresponding author

Correspondence to Clive P. Duncan MB, MSc, FRCSC.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Division of Lower Limb Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia.

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Leung, F., Richards, C.J., Garbuz, D.S. et al. Two-stage Total Hip Arthroplasty: How Often Does It Control Methicillin-resistant Infection?. Clin Orthop Relat Res 469, 1009–1015 (2011). https://doi.org/10.1007/s11999-010-1725-6

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  • DOI: https://doi.org/10.1007/s11999-010-1725-6

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