Clinical Orthopaedics and Related Research®
Volume 469, Number 4, 1009-1015, DOI: 10.1007/s11999-010-1725-6

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The Association of Bone and Joint Surgeons®

Symposium: Periprosthetic Joint Infection

Two-stage Total Hip Arthroplasty: How Often Does It Control Methicillin-resistant Infection?

Fay Leung, Corey J. Richards, Donald S. Garbuz, Bassam A. Masri and Clive P. Duncan

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Abstract

Background  

Methicillin-resistant hip infections are increasingly common. Reports of the surgical management of these patients using two-stage THA show variable control of infection, but all reports used static spacers.

Questions/purposes  

We therefore determined (1) the rate of successful control of infection and (2) function in patients with methicillin-resistant infection treated with a two-stage THA using an articulated cement spacer during the first stage.

Methods  

We retrospectively reviewed 50 patients who had a two-stage revision THA for methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis infection. Twelve patients died, leaving 38 for review. All eligible patients completed quality-of-life outcome questionnaires (WOMAC, SF-12, Oxford-12, UCLA activity score, hip and knee satisfaction score). Minimum followup was 24 months after the second stage (mean, 58 months; range, 24–123 months).

Results  

Of the 38 patients, eight (21%) had recurrence of their infection requiring further revision surgery. Of the remaining 27 patients, the mean WOMAC was 62, mean Oxford-12 60, mean UCLA activity score 4.3, and mean hip and knee satisfaction score 66.

Conclusions  

We found a treatment failure rate of 21% for patients with methicillin-resistant S. aureus or methicillin-resistant S. epidermidis infection. This is a higher rate than reported for two-stage THA for studies including patients infected with both nonresistant and resistant organisms. The functional scores for patients were also lower than those reported in the literature.

Level of Evidence  

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at the Division of Lower Limb Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia.

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