Clinical Outcome of First Stage in Two Stages Treatment of Cementless Chronic Infected THA

Abstract

Total hip arthroplasty is one of the most affluent surgeries in Orthopedics. However, postoperative complications including the infection remains one of the challenges, There are different ways to treat the infection, one of them is the two-stage surgeries first stage is to remove the implant and to put antibiotics handmade spacer and second stage for reimplantation of cementless prosthesis. To evaluate the clinical outcome of using handmade mobile antibiotics spacer in first stage of two stages treatment chronic cementless THA. This is an intervention study, which was conducted, in Medical City teaching complex, in the period between October 2017 and August 2018. All the patients presented during the study period and was operated by the same surgical team. A total number of 11 patients were included in this study all of them had sinus of chronic infected THA. The patients were operated for removal of primary cement less total hip arthroplasty and use handmade antibiotics spacer through an old scar of postero-lateral approach to the hip. The functional outcome of this intervention was assessed by using Harris hip score to assess the functional outcome 6 weeks after spacer. There is significant increase in the functional outcome in comparison between pre-operative and 6weeks after, the pain, limping, distance of walking are the important variant got improved after spacer applied, some of the mechanical complication was happen during first stage, one case of dislocation treated by limited weight bearing till the second stage, three cases developed proximal fracture treated definitely during second stage. First stage in two-stage treatment of infected total hip arthroplasty is functionally effective in treatment according to the result of Harris hip score, pain and walking are the most clinical variant which are significantly improved after first stage, Limb lengths are maintained, and the patient has minimal discomfort between stages, At the second- stage procedure, soft-tissue planes are easier to identify and joint range of motion is maintained. However, larger study sample and this study could be the scope for further studies to follow in the future.