Concerns with the two-stage revision of chronically infected total hip arthroplasty (THA) motivated top researchers in China to take another look—this time via a 126-patient study.
The study, “Single-stage treatment of chronically infected total hip arthroplasty with cementless reconstruction,” was published in the March 31, 2019 edition of The Bone and Joint Journal.
Li Cao M.D., with the Department of Orthopedic Surgery at the First Affiliated Hospital of Xinjiang Medical University in Urumqi, Xinjiang, China, explained the origin of the study to OTW, “As we all know, periprosthetic hip infection is a catastrophic complication after total hip arthroplasty. It requires not only tremendous medical efforts but also involves huge healthcare costs.”
“When facing a scenario with a chronic infection, the two-stage revision procedure, regarded by many to be the standard of care, appears more reasonable because [there is] more opportunity to eradicate the infection. However, the period of this procedure is too long to complete, and according to reports, a considerable number of patients undergoing the first stage of a two-stage procedure are not having a subsequent reimplantation for a variety of reasons.”
“Moreover, it should be noted that the mortality associated with two-stage revision is always de-emphasized; there was recently reported a 40% rate of death at an average of 4.7 years after the treatment which is much higher than in one-stage revision. Slow functional rehabilitation and high healthcare costs are two additional concerns that led us to perform this study.”
“After reviewing our cases, we found an 89.2% infection control rate at a mean follow-up time of 58 months (24 to 107). These are the results in 126 patients with broad inclusion criteria of single-stage revision which include patients with sinus tract, culture-negative results, fungal infection and multidrug-resistant organisms.”
“However, we have got a comparable infection control rate with recent published data of two-stage revision that reported an 85%-90% infection control rate at 5 years and better Harris Hip scores than their results in the spacer phase. What’s more, we noted lower morbidity rates, and less total expense.”
“We’d like to give two recommendations. Firstly, you should have a multidisciplinary team before you make a decision to perform a single-stage revision, including a microbiologist, nutritionist, pharmacist, special operative team and nursing team.”
“Secondly, this procedure could only be performed in tertiary hospitals and the surgeons there must be experienced in management of periprosthetic joint infection and should know how to perform really radical debridement.”
“According to the data, it is no longer a question of whether we should perform single-stage revision but more having clear criteria for when to do it. So-called ‘absolute contraindications’ of single-stage revision may need to be reconsidered. With the appearance of high-quality evidence in the future, single-stage may eventually replace the two-stage-revision.”
