Article

Controversies still exist regarding the best surgical
procedure in the treatment of periprosthetic infection after total hip
arthroplasty (THA). Based on data in the Norwegian Arthroplasty Register (NAR),
we have compared the risk of re-revision after 4 different surgical procedures:
2-stage with exchange of the whole prosthesis, 1-stage with exchange of the whole
prosthesis, major partial 1-stage with exchange of stem or cup, and minor partial
1-stage with exchange of femoral head and/or acetabular liner. METHODS: Between
1987 and 2009, 124,759 primary THAs were reported to the NAR, of which 906 (0.7%)
were revised due to infection. Included in this study were the 784 revisions that
had been performed by 1 of the 4 different surgical procedures. Cox-estimated
survival and relative revision risks are presented with adjustment for
differences among groups regarding gender, type of fixation, type of prosthesis,
and age at revision. RESULTS: 2-stage procedures were used in 283 revisions
(36%), 1-stage in 192 revisions (25%), major partial in 129 revisions (17%), and
minor partial in 180 revisions (23%). 2-year Kaplan-Meier survival for all
revisions was 83%; it was 92% for those re-revised by 2-stage exchange procedure,
88% for those re-revised by 1-stage exchange procedure, 66% for those re-revised
by major partial exchange procedure, and it was 76% for those re-revised by minor
partial exchange. Compared to the 2-stage procedure and with any reason for
revision as endpoint (180 re-revisions), the risk of re-revision increased 1.4
times for 1-stage (p = 0.2), 4.1 times for major partial exchange (p < 0.001),
and 1.5 times for minor partial exchange (p = 0.1). With infection as the
endpoint (108 re-revisions), the risk of re-revision increased 2.0 times for
1-stage exchange (p = 0.04), 6.0 times for major partial exchange (p < 0.001),
and 2.3 times for minor partial exchange (p = 0.02). Similar results were found
when the analyses were restricted to the period 2002-2009. INTERPRETATION: In the
Norwegian Arthroplasty Register, the survival after revision of infected primary
THA with 2-stage implant exchange was slightly superior to that for 1-stage
exchange of the whole prosthesis. This result is noteworthy, since 2-stage
procedures are often used with the most severe infections. However, debridement
with exchange of head and/or liner but with retention of the fixed implant (minor
revision) meant that there was a 76% chance of not being re-revised within 2
years.

Langue : ANGLAIS