Complications Associated with Reimplantation After
Girdlestone Arthroplasty
CORR No. 407, pp. 119-126, Feb. 2003, William P.H. Charlton et al.
Rothman Institute Orthopaedics, Thomas Jefferson University, Philadelphia, PA
Objective: To report the complications and results of reimplantation total hip
arthroplasty for patients treated with resection arthroplasty for hip infection.
Materials and Method:
*Till Nov. of 1997, 101 hips (100 patients) have received op. for infected hip prosthesis.
*58 hips (57 patients) have had a two-stage exchange protocol, 6 pt’s (7 hips) died of
unrelated causes, incomplete FU in 7 cases.
*44 hips in 44 patients with mininum 2-year followup (range, 2-9 years), 22 men and 22
women, mean age : 63 (32-85).
*Average 3.5 operations before resectional arthroplasty. 7: prior surgery for a prosthetic
hip infection; 14: infected primary THA; 12: infected revision THA; 8: previous
infected hardware; 3: previous infected hemiarthroplasty.
*38 positive cultures from preoperative aspirates or surgical tissue specimens. All had
documentation of the isolotaion of causal organisms at another institution.
*All reimplantations were preceded by a resection arthroplasty: removal of all hardware
and cement, extensive debridement, irrigation, and limited bone resection.
*Cement spacers consisting of antibiotic impregnated PMMA were used in 30 hips
(Tobramycin in 26 hips, Tobramycin and Vancomycin in 4 hips, 1.2g/vial of mement).
*A 6-week course of parenteral antibiotic treatment based on the sensitivity tests.
*Reimplantation:.3 months (14weeks – 22 months), one surgeon, cancellous allograft
used in all hips, 11 bulk femoral allograft, 3 cortical only strut allograft. 37 uncemented
femoral components, 35 uncemented acetabular components.
*FU (pre-op., 6 months post-op. and then yearly): Charnley’s modified D’Aubigne and
Postel scale (1~6 ) for pain, function and motion; Harris hip scoring system, and
radiographic evaluation for loosening.
Results:
*Charnley’s modified scale
Pre-op.
Post-op.
Pain
3.2
5.2
Function
2.8
4.3
ROM
4.6
5.1
40
78
Harris Hip Score
*Two patients required subsequent revision: one for recurrent infection, one for recurrent
dislocation
*LLD:
Pre-op.
Post-op.
30.5mm (3-100mm)
6.5mm (5-30mm, 50% normal)
*Limping: 39%, 12% severe.
*Functional evaluation: 45% could walk at least 6 blocks, 43% could put on shoes, 73%
could climb stairs, 68% could sit in any chair for 1 hour, and 57% could take public
transportation.
*Radiographic analysis:
Acetabulum
Cemented
Cementless
0 loosen (7)
all stable (37)
1 osteolysis
(found at 2 yrs, stable at 6 yrs)
Femur
0 loosen (7)
36 stable (37)
1 loosen (no symptom)
*Complications
Nonprosthesis-related: CHF (2), diarrhea (2), angina (1), arrhythmia (1), transfusion
reaction (1), urinary retention (1), UTI (1).
Prosthesis-related: postoperative wound drainage (1), hematoma (1), trochanteric
nonunion (4), heterotopic ossification (1), early and late dislocation (5), recurrent
infection (1).
Conclusion: in Deep Infected THA
*Resectional arthroplasty: LLD of 3-6cm, need walking aids, inadequate pain relief.
*Current study: Successful rate 97.6% (1 stage: 38.5% ~ 90%, 2 stage: 60% ~ 100%.)
Nonprosthetic–related complications: 23%
Local complications: 33%
Dislocation: 11.4% (3.8~18%)
Persistent limping: 39%
2003/06/16