Acta Medica Okayama 71巻 4号
2017-08 発行

A Strategic Protocol to Improve the Process and Outcomes of Two-stage Revision Total Hip Arthroplasty

Taniguchi, Takaya Department of Orthopaedic Surgery, Wakayama Medical University
Taniguchi, Wataru Department of Orthopaedic Surgery, Wakayama Medical University
Miyamoto, Erabu Department of Orthopaedic Surgery, Wakayama Medical University
Miyazaki, Nobuyuki Department of Orthopaedic Surgery, Wakayama Medical University
Yoshida, Munehito Department of Orthopaedic Surgery, Wakayama Medical University
Publication Date
2017-08
Abstract
Two-stage revision total hip arthroplasty (THA) is the most commonly used treatment approach for deep prosthetic infection. However, in this approach the interval between the first and second stage tends to be prolonged. We devised a strategic protocol for improving the infection eradication rate and shortening the interval between the stages in two-stage revision THA. This study analyzed a series of 14 patients (14 hips) from 2008 to 2012, who were treated using an antibiotic-loaded acrylic cement (ALAC) spacer at the first stage and re-implantation at the second stage. The ALAC included vancomycin and amikacin for most of the cases. Patients with MRSA infection were additionally administered intravenous vancomycin in combination with either oral rifampicin or trimethoprim-sulfamethoxazole. The average interval between the stages was 54.2 days overall, and 58.7 days for cases with MRSA infection. Our infection eradication rate was 100%, with no reported recurrence of infection. The presence of MRSA tended to be associated with a longer interval between the two stages. Our protocol for two-stage revision THA was associated with a high eradication rate of infection and a shortened interval between the stages.
Document Type
Original Article
Keywords
two-stage revision
infection
total hip arthroplasty
antibiotic-loaded acrylic cement,
methicillinresistant Staphylococcus aureus (MRSA)
Link to PubMed
Thumnail 71_4_301.pdf 1.98 MB