Study Of Two-stage Total Hip Arthroplasty For Infected Internal Fixation Of Hip Peripheral Fractures

Objective: The purpose of the present study was to evaluate the application and clinical results of two-stage total hip arthroplasty in treatment of the deep hip infection following the internal fixation of hip peripheral fractures.Materials and Methods: Between January 2006 and December 2015, 33 patients (27 men and 6 women) with active hip infection secondary to internal fixation of hip peripheral fracture were treated with two-stage total hip arthroplasty using a temporary antibiotic-loaded cement spacers. There are 10 acetabular fractures, 20 femoral neck fractures, 3 intertrochanteric fractures. All patients were treated with antibiotics prior to admission and 12 patients had a history of debridement. One stage operation mainly includes that removing the internal fixation materials, debriding and implanting a antibiotic-loaded cement spacer. After operation interval with systemic antibiotic therapy, two stage operation is finished involving the removel of temporary spacer and the implantation of hip prosthesis. According to serologic examination, X-ray and Harris hip score, the clinical results were evaluated.Results: All patients successfully completed two operations under general anesthesia with tracheal intubation. The interval was 11 to 44 weeks (mean, 20weeks) and one spacer was broken off. The patients were followed up 13?124months ( mean, 57 months)and infections were eradicated in all hips. 2cases of posterior hip dislocation of acetabular fractures were treated well with closed reduction under anesthesia and the hip spica for 6weeks. Harris hip function scores before first operation, interval and last follow-up were 24.73 ± 10.74?49.58 ± 12.41?89.73 ±5.38. At latest fellow-up, the quality of life improved significantly, the location of prosthesis were well and the function of hip joint was satisfied.Conclusion: By means of an antibiotic-loaded cement spacer, two-stage total hip arthroplasty is an effective salvage procedure to the infected internal fixation of hip peripheral fractures, eradicating infection and providing functional improvement.According to different fracture sites and their internal fixation, it is necessary for each patient to adopt the personalized treatment by implanting appropriate type of antibiotic cement spacer and joint prosthesis, grasping the timing of hip prosthesis implantation and selecting the appropriate bone defect reconstruction technology.