Selective Component Retainment in the Treatment of Chronic Periprosthetic Infection After Total Hip Arthroplasty: A Systematic Review

INTRODUCTION:

Chronic infections after a total hip arthroplasty (THA) are a devastating complication and are usually treated by a complete revision of components. Selective revision, with preservation of well-fixed components, has been previously reported. We did a systematic review to report on success rates of selective revision in chronic infections after THA.

METHODS:

PubMed, Web of Science, and the Cochrane Database were systematically searched for studies reporting on partial-retaining revision for chronically infected THA. These were reviewed to determine success rates based on component revised, as well as infectious organism.

RESULTS:

Nine studies reported on 134 patients. The majority of the patients underwent femoral-retaining procedures (118), and the rest of the patients underwent acetabular-retaining procedures (16). Average follow-up was 60.56 months, and the success rates were 80% for femoral revision, 90.43% for acetabular revision, and overall success rate was 89.41%.

DISCUSSION:

In select patients, retainment of well-fixed components in chronically infected THA may be considered. Although reported success rates are high, and comparable with complete revision arthroplasty in cases of chronic infections, the quality of the studies included is poor. The studies lacked sufficient internal validity, sample size, methodological consistency, and standardization of protocols and outcomes.

LEVEL OF EVIDENCE:

Systematic review of level IV studies.

 2019 Oct 24. doi: 10.5435/JAAOS-D-19-00457. [Epub ahead of print]