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.	康鹏德, 裴福兴, 王坤正. 感染后髋关节的初次人工关节置换. 中华骨科杂志, 2005, 25(7): 404-408.
4.	谭钢, 罗磊, 杨静, 等. 3664例全髋关节置换术相关危险因素分析. 中国矫形外科杂志, 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.	卢宏章, 朱天岳, 柴卫兵, 等. 感染后关节的初次人工关节置换术. 中华骨科杂志, 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.	张亮, 李玉军, 郭晓忠, 等. 人工全髋关节置换术治疗髋关节感染继发骨关节炎的中期疗效. 中国修复重建外科杂志, 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.	吕宁. 闭合复位空心钉内固定和人工全髋关节置换治疗股骨颈骨折的临床疗效分析. 大连: 大连医科大学, 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.	李满江, 王智勇, 张志强. 血清降钙素原在诊断关节置换术后早期感染的临床意义. 中华骨与关节外科杂志, 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. 康鹏德, 裴福兴, 王坤正. 感染后髋关节的初次人工关节置换. 中华骨科杂志, 2005, 25(7): 404-408.
4. 谭钢, 罗磊, 杨静, 等. 3664例全髋关节置换术相关危险因素分析. 中国矫形外科杂志, 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. 卢宏章, 朱天岳, 柴卫兵, 等. 感染后关节的初次人工关节置换术. 中华骨科杂志, 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. 张亮, 李玉军, 郭晓忠, 等. 人工全髋关节置换术治疗髋关节感染继发骨关节炎的中期疗效. 中国修复重建外科杂志, 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. 吕宁. 闭合复位空心钉内固定和人工全髋关节置换治疗股骨颈骨折的临床疗效分析. 大连: 大连医科大学, 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. 李满江, 王智勇, 张志强. 血清降钙素原在诊断关节置换术后早期感染的临床意义. 中华骨与关节外科杂志, 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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