Artikel
Reconstruction of hip geometry after periprosthetic hip joint infection treated by two-stage exchange procedure with intermediate girdlestone resection arthroplasty
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Autoren
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Jan Hubert
- Klinik f. Unfallchirurgie, Orthopädie & Plastische Chirurgie, Göttingen, Germany
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Frank Timo Beil
- Klinik f. Unfallchirurgie, Orthopädie & Plastische Chirurgie, Göttingen, Germany
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Wolfgang Lehmann
- Klinik f. Unfallchirurgie, Orthopädie & Plastische Chirurgie, Göttingen, Germany
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Thelonius Hawellek
- Klinik f. Unfallchirurgie, Orthopädie & Plastische Chirurgie, Göttingen, Germany
| Veröffentlicht: | 6. November 2018 |
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Gliederung
Text
Objectives: Periprosthetic joint infection (PJI) after primary total hip arthroplasty (pTHA) can be treated surgically by two-stage exchange procedure with intermediate girdlestone resection arthroplasty (GRA), whereby the risk of tissue contraction with a higher failure rate of hip geometry reconstruction is controversially discussed. The aim was to assess changes of various radiographic parameters of hip joint geometry during PJI treatment and to evaluate the influence of the applied GRA on the final reconstruction after reimplantation (reTHA).
Methods: 47 patients (n=23 female and n=24 male, mean age at time of GRA: 64.1years, SD±12.9, range 41-88) with a periprosthetic hip joint infection, who underwent a surgical two-stage exchange procedure with intermediate GRA between 2000 and 2016 were included in this retrospective study. Radiographic parameters (leg length (LL), femoral offset (FO), horizontal/vertical acetabular center of rotation distance (h/vCORD)) were measured on standard X-rays of the pelvis and compared between four different stages during PJI treatment (healthy status (HS), pTHA, GRA and reTHA). The duration of GRA (mean 10.9month, SD±11.8, range: 1.8-72.1) and the number of reoperations during this period (mean n=2.04, SD±2.01, range:0-8) as well as their impact on hip geometry reconstruction were evaluated.
Results and conclusion: Comparing HS with pTHA respectively reTHA an equivalent reconstruction was measured regarding the FO (p<0.001/p<0.001) and hCORD (p=0.016/p<0.001), but not regarding the LL (p=0.19/p=0.51) and vCORD (p=1/p=1). In contrast, analysis revealed no influence of GRA and an equivalent reconstruction of LL (p=0.003), FO (p<0.001), v/hCORD (p=0.039/p=0.035) after reTHA in comparison to pTHA (Figure 1 [Fig. 1]). Furthermore, GRA duration (p=0.053) or the number of reoperations after applied GRA (p=0.134) had no impact on radiographic hip geometry reconstruction.
Our data shows a good reconstruction of hip joint geometry after reTHA, whereby two-stage exchange procedure with intermediate GRA does not alter the preexisting radiographic hip parameters during PJI treatment and has independent of GRA duration or the number of reoperations no impact on the final hip geometry reconstruction.
