DOS Kongressen 2014 ·
203
Outcome of Two-stage revision of chronic
infections in hip joint replacement in Denmark
2003-2008.
Jeppe Lange, Alma B. Pedersen, Anders Troelsen, Kjeld Søballe
Lundbeckfoundation Centre for Fast-track Hip and Knee Surgery, Tage-
Hansens Gade 2, 8000 Aarhus, Den, Department of Orthopaedic Surgery,
Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus, Den;
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes
Allé 43-45, 8200 Aarhus, Denmark; Department of Orthopaedic Surgery,
Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650 Hvidovre
Denmark
Background:
Chronic infections in a hip joint replacement (CIHJR) is believed
to occur in less than ½% of patients. Currently, the gold-standard treatment for
CIHJR is a two-stage revision. Little is known on the overall status of this treat-
ment in Denmark (DK).
Purpose / Aim of Study:
We aimed to investigate the outcome of two- stage
revision in DK.
Materials and Methods:
We identified patients in the Danish National Patient
Registry from 2003-2008 in 11 orthopaedic departments with a primary and
secondary ICD10 discharge diagnosis of T84.5 in combination with a hip joint
specific procedure code or a hip joint specific infectious surgical procedure code
independently of ICD10 code. Patients with a total hip-, hemi hip- or resurfac-
ing hip arthroplasty, a diagnosis of deep infection adapted from the American
Musculoskeletal Infection Society and more than 6 weeks since latest surgery
to the hip joint were defined as having CIHJR (n=114).
Findings / Results:
Two-stage revision of the index CIHJR was performed in 80
of 114 (70%) patients. Mean age in the two-stage cohort was 68 years (range
36-92), 35 (44%) were female and 73 (91%) had ASA 1 or 2. 15 (19%) of the
index CIHJR were revision prosthesis and 25 (31%) presented with a chronic
fistula.49 (61%) had spacer in the interim period. At removal of index CIHJR,
Kamme- biopsies were culture negative in 23 (29%). 58 (73%) had cementless
stem and 60 (75%) had cementless cup implanted at 2. revision. Median follow
up was 7.4 years (range 4-11). 60 (75%) were not revised due to re-infection.
However, of these 60, 15 (25%) were revised due to aseptic causes. 28 (35%)
died during follow up.
Conclusions:
Two-stage revision in DK appears to give overall acceptable re-
sults. However, hip surgeons must keep in mind that 30% of all chronic infec-
tions are not treated with this surgical procedure.
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