MID-TERM RESULTS OF TOTAL HIP ARTHROPLASTY FOR OSTEOARTHRITIS SECONDARY TO HIP SEPSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGLiang , LIYujun , GUOXiaozhong , XUHui ,  ZHOUYixin

Department of Adult Joint Reconstructive Surgery, Jishuitan Hospital, Beijing, 100035, P. R. China;

Corresponding author：

ZHOUYixin, Email: orthoyixin@yahoo.com

Keywords：

Total hip arthroplasty; Old hip sepsis; Osteoarthritis

DOI：

10.7507/1002-1892.20140047

Video：

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Objective To evaluate mid-term results of total hip arthroplasty (THA) for treatment of osteoarthritis secondary to hip sepsis. Methods Between February 2003 and January 2009, 62 patients (62 hips) with osteoarthritis secondary to hip sepsis underwent THA. There were 32 males and 30 females with an average age of 39.9 years (range, 18-67 years). The original infection included pyogenic arthritis in 40 hips and tuberculosis in 22 hips. After infection, 35 patients underwent non-operative treatment, and 27 patients received operative management. The average time interval between initial infection and THA was 28.7 years (range, 12-53 years). The preoperative Harris hip score was 24.6±9.2. The Trendelenburg sign was positive in all hips. Leg discrepancy was observed in 25 cases, and the mean discrepancy of bilateral lower extremities was 3.8 cm (range, 2.6-6.5 cm) preoperatively. All hips had no evidence of active hip sepsis. Results All patients were followed up 72 months on average (range, 54-115 months). Intraoperative complications included sciatic nerve injury (2 cases) and femoral shaft fractures (2 cases); postoperative complications included hip anterior dislocation (1 case) and periprosthetic infection (1 case). At last follow-up, 1 hip, 5 hips, 18 hips, and 38 hips were found to have severe pain, moderate pain, slight pain, and no pain respectively. Claudication occurred in 30 patients (mild in 19, moderate in 8, and severe in 3). The Trendelenburg sign was positive in 18 hips. After THA, only 5 patients had a leg length discrepancy of 2.9 cm on average (range, 2.6-3.5 cm). The Harris score was significantly increased to 82.3±11.4 at last follow-up when compared with preoperative one (t=-31.241, P=0.000). The results of subjective satisfaction were very satisfactory in 43 cases, satisfactory in 12 cases, unsatisfactory in 4 cases, and unsatisfactory at all in 3 cases. No sign of aseptic loosening of prosthesis was found during follow-up period. Roentgenographic results showed no radiolucent line or osteolysis in the other patients except 2 patients having local radiolucent. After THA, 12 hips had heterotopic ossification. Conclusion The mid-term clinical and radiographic results of THA for treatment of osteoarthritis secondary to hip sepsis are good, with the advantages of high satisfactory rate, good function recovery, and low complication incidence.

Citation： ZHANGLiang, LIYujun, GUOXiaozhong, XUHui, ZHOUYixin. MID-TERM RESULTS OF TOTAL HIP ARTHROPLASTY FOR OSTEOARTHRITIS SECONDARY TO HIP SEPSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(2): 218-222. doi: 10.7507/1002-1892.20140047 Copy

1.	Choi IH,Pizzutillo PD,Bowen JR,et al.Sequelae and reconstruction after septic arthritis of the hip in infants.J Bone Joint Surg (Am),1990,72(8):1150-1165.
2.	Choi IH,Shin YW,Chung CY,et al.Surgical treatment of the severe sequelae of infantile septic arthritis of the hip.Clin Orthop Relat Res,2005,(434):102-109.
3.	Cherney DL,Amstutz HC.Total hip replacement in the previously septic hip.J Bone Joint Surg (Am),1983,65(9):1256-1265.
4.	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.
5.	Jupiter JB,Karchmer AW,Lowell JD,et al.Total hip arthroplasty in the treatment of adult hips with current or quiescent sepsis.J Bone Joint Surg (Am),1981,63(2):194-200.
6.	Kim YY,Ko CU,Lee SW,et al.Replacement arthroplasty using the Charnley prosthesis in old tuberculosis of the hip.Int Orthop,1979,3(1):81-88.
7.	Laforgia R,Murphy JC,Redfern TR.Low friction arthroplasty for old quiescent infection of the hip.J Bone Joint Surg (Br),1988,70(3):373-376.
8.	Kim YH.Total arthroplasty of the hip after childhood sepsis.J Bone Joint Surg (Br),1991,73(5):783-786.
9.	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.
10.	Mahomed NN,Liang MH,Cook EF,et al.The importance of patient expectations in predicting functional outcomes after total joint arthroplasty.J Rheumatol,2002,29(6):1273-1279.
11.	DeLee JG,Charnley J.Radiological demarcation of cemented sockets in total hip replacement.Clin Orthop Relat Res,1976,(121):20-32.
12.	Gruen TA,McNeice GM,Amstuts HC. "Modes of failure" of cemented stem-type femoral components:a radiographic analysis of loosening.Clin Orthop Relat Res,1979,(141):17-27.
13.	Joshi RP,Eftekhar NS,McMahon DJ,et al.Osteolysis after Charnley primary low-friction arthroplasty.A comparison of two matched paired groups.J Bone Joint Surg (Br),1998,80(4):585-590.
14.	Maloney WJ,Jasty M,Harris WH,et al.Endosteal erosion in association with stable uncemented femoral components.J Bone Joint Surg (Am),1990,72(7):1025-1034.
15.	Harris WH,McGann WA.Loosening of the femoral component after use of the medullary-plug cementing technique.Follow-up note with a minimum five-year follow-up.J Bone Joint Surg (Am),1986,68(7):1064-1066.
16.	Engh CA,Massin P,Suthers KE.Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components.Clin Orthop Relat Re,1990,(257):107-128.
17.	Brooker AF,Bowerman JW,Robinson RA,et al.Ectopic ossification following total hip replacemen.Incidence and a method of classification.J Bone Joint Surg (Am),1973,55(8):1629-1632.
18.	Kim YH,Oh SH,Kim JS.Total hip arthroplasty in adult patients who had childhood infection of the hip.J Bone Joint Surg (Am),2003,85-A (2):198-204.
19.	Lim SJ,Park YS.Modular cementless total hip arthroplasty for hip infection sequelae.Orthopedics,2005,28(9 Suppl):1063-1068.
20.	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.
21.	Yoo MC,Cho YJ,Kim KI,et al.Cementless total hip arthroplasty with medial wall osteotomy for the sequelae of septic arthritis of the hip.Clin Orthop Surg,2009,1(1):19-26.
22.	Lian YY,Yoo MC,Pei FX,et al.Circumferential osteotomy of the medial acetabular wall in total hip replacement for the late sequelae of childhood septic arthritis of the hip.J Bone Joint Surg (Br),2007,89(9):1149-1154.
23.	Kim YH,Seo HS,Kim JS.Outcomes after THA in patients with high hip dislocation after childhood sepsis.Clin Orthop Relat Res,2009,467(9):2371-2378.

1. Choi IH,Pizzutillo PD,Bowen JR,et al.Sequelae and reconstruction after septic arthritis of the hip in infants.J Bone Joint Surg (Am),1990,72(8):1150-1165.
2. Choi IH,Shin YW,Chung CY,et al.Surgical treatment of the severe sequelae of infantile septic arthritis of the hip.Clin Orthop Relat Res,2005,(434):102-109.
3. Cherney DL,Amstutz HC.Total hip replacement in the previously septic hip.J Bone Joint Surg (Am),1983,65(9):1256-1265.
4. 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.
5. Jupiter JB,Karchmer AW,Lowell JD,et al.Total hip arthroplasty in the treatment of adult hips with current or quiescent sepsis.J Bone Joint Surg (Am),1981,63(2):194-200.
6. Kim YY,Ko CU,Lee SW,et al.Replacement arthroplasty using the Charnley prosthesis in old tuberculosis of the hip.Int Orthop,1979,3(1):81-88.
7. Laforgia R,Murphy JC,Redfern TR.Low friction arthroplasty for old quiescent infection of the hip.J Bone Joint Surg (Br),1988,70(3):373-376.
8. Kim YH.Total arthroplasty of the hip after childhood sepsis.J Bone Joint Surg (Br),1991,73(5):783-786.
9. 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.
10. Mahomed NN,Liang MH,Cook EF,et al.The importance of patient expectations in predicting functional outcomes after total joint arthroplasty.J Rheumatol,2002,29(6):1273-1279.
11. DeLee JG,Charnley J.Radiological demarcation of cemented sockets in total hip replacement.Clin Orthop Relat Res,1976,(121):20-32.
12. Gruen TA,McNeice GM,Amstuts HC. "Modes of failure" of cemented stem-type femoral components:a radiographic analysis of loosening.Clin Orthop Relat Res,1979,(141):17-27.
13. Joshi RP,Eftekhar NS,McMahon DJ,et al.Osteolysis after Charnley primary low-friction arthroplasty.A comparison of two matched paired groups.J Bone Joint Surg (Br),1998,80(4):585-590.
14. Maloney WJ,Jasty M,Harris WH,et al.Endosteal erosion in association with stable uncemented femoral components.J Bone Joint Surg (Am),1990,72(7):1025-1034.
15. Harris WH,McGann WA.Loosening of the femoral component after use of the medullary-plug cementing technique.Follow-up note with a minimum five-year follow-up.J Bone Joint Surg (Am),1986,68(7):1064-1066.
16. Engh CA,Massin P,Suthers KE.Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components.Clin Orthop Relat Re,1990,(257):107-128.
17. Brooker AF,Bowerman JW,Robinson RA,et al.Ectopic ossification following total hip replacemen.Incidence and a method of classification.J Bone Joint Surg (Am),1973,55(8):1629-1632.
18. Kim YH,Oh SH,Kim JS.Total hip arthroplasty in adult patients who had childhood infection of the hip.J Bone Joint Surg (Am),2003,85-A (2):198-204.
19. Lim SJ,Park YS.Modular cementless total hip arthroplasty for hip infection sequelae.Orthopedics,2005,28(9 Suppl):1063-1068.
20. 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.
21. Yoo MC,Cho YJ,Kim KI,et al.Cementless total hip arthroplasty with medial wall osteotomy for the sequelae of septic arthritis of the hip.Clin Orthop Surg,2009,1(1):19-26.
22. Lian YY,Yoo MC,Pei FX,et al.Circumferential osteotomy of the medial acetabular wall in total hip replacement for the late sequelae of childhood septic arthritis of the hip.J Bone Joint Surg (Br),2007,89(9):1149-1154.
23. Kim YH,Seo HS,Kim JS.Outcomes after THA in patients with high hip dislocation after childhood sepsis.Clin Orthop Relat Res,2009,467(9):2371-2378.

Chinese Journal of Reparative and Reconstructive Surgery

MID-TERM RESULTS OF TOTAL HIP ARTHROPLASTY FOR OSTEOARTHRITIS SECONDARY TO HIP SEPSIS

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