The Transfemoral Approach for Removal of Well-Fixed Femoral Stems in 2-Stage Septic Hip Revision
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The Transfemoral Approach for Removal of Well-Fixed Femoral Stems in 2-Stage Septic Hip Revision. / Fink, Bernd; Oremek, Damian.
In: J ARTHROPLASTY, Vol. 31, No. 5, 05.2016, p. 1065-71.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - The Transfemoral Approach for Removal of Well-Fixed Femoral Stems in 2-Stage Septic Hip Revision
AU - Fink, Bernd
AU - Oremek, Damian
N1 - Copyright © 2016 Elsevier Inc. All rights reserved.
PY - 2016/5
Y1 - 2016/5
N2 - BACKGROUND: The value of a transfemoral approach for removal of well-fixed infected hip arthroplasties in 2-stage revision is unclear, especially whether cerclages for closure of the flap in the first step lead to higher reinfection rates and whether reopening of the flap for reimplantation of a hip arthroplasty leads to a lower union rate of the bony flap.METHODS: Seventy-six septic 2-stage revisions via a transfemoral approach with cerclages for closure of the flap in the first step and reopening of the flap for reimplantation were followed prospectively for a mean period of 51.2 ± 23.2 (24-118) months.RESULTS: The union rate of the bony flap after reimplantation was 98.7%, and no recurrence of reinfection was recorded in 93.4% of all cases. Subsidence of the stem occurred at a rate of 6.6%, dislocation at a rate of 6.6%, and there was no aseptic loosening of the implants. The Harris Hip Score was 62.2 ± 12.6 points with the spacer and 86.6 ± 15.5 points 2 years after reimplantation. Nine fractures (11.8%) of the flap occurred during the operation because of osteolytic or osteoporotic weakness of the flap itself, but these all healed without further intervention.CONCLUSION: The transfemoral approach is a safe method for septic revision of well-fixed hip prostheses, and the use of cerclage wires for closing the osteotomy flap in the first stage does not appear to lead to a higher reinfection rate. Similarly, the reopening of the flap does not appear to decrease the union rate of the flap.
AB - BACKGROUND: The value of a transfemoral approach for removal of well-fixed infected hip arthroplasties in 2-stage revision is unclear, especially whether cerclages for closure of the flap in the first step lead to higher reinfection rates and whether reopening of the flap for reimplantation of a hip arthroplasty leads to a lower union rate of the bony flap.METHODS: Seventy-six septic 2-stage revisions via a transfemoral approach with cerclages for closure of the flap in the first step and reopening of the flap for reimplantation were followed prospectively for a mean period of 51.2 ± 23.2 (24-118) months.RESULTS: The union rate of the bony flap after reimplantation was 98.7%, and no recurrence of reinfection was recorded in 93.4% of all cases. Subsidence of the stem occurred at a rate of 6.6%, dislocation at a rate of 6.6%, and there was no aseptic loosening of the implants. The Harris Hip Score was 62.2 ± 12.6 points with the spacer and 86.6 ± 15.5 points 2 years after reimplantation. Nine fractures (11.8%) of the flap occurred during the operation because of osteolytic or osteoporotic weakness of the flap itself, but these all healed without further intervention.CONCLUSION: The transfemoral approach is a safe method for septic revision of well-fixed hip prostheses, and the use of cerclage wires for closing the osteotomy flap in the first stage does not appear to lead to a higher reinfection rate. Similarly, the reopening of the flap does not appear to decrease the union rate of the flap.
KW - Journal Article
U2 - 10.1016/j.arth.2015.11.008
DO - 10.1016/j.arth.2015.11.008
M3 - SCORING: Journal article
C2 - 26725137
VL - 31
SP - 1065
EP - 1071
JO - J ARTHROPLASTY
JF - J ARTHROPLASTY
SN - 0883-5403
IS - 5
ER -
