Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties

Figures & data

Figure 1. Surgical treatment algorithm for prosthetic joint infections. Modified according to Trampuz and Zimmerli (2005).

Figure 2. 57-year-old male patient (2-stage exchange, ETO, Wagner SL, ARR). Girdlestone hip (a) due to difficult-to-treat bacteria (small-colony variant of S. aureus), postoperatively (b), and after 3 months (c). Complete remodeling of the proximal femur at 5 years (d).

Table 1. Etiology of the 81 episodes of PJI. The total number of microorganisms was higher than the number of episodes, because 14 episodes were polymicrobial

Bacteria	Total no.	1-stage	2-stage
Coagulase-negative staphylococci	27	11	16
Staphylococcus aureus ^a^, ^b	26	7	19
Streptococcus spp.	14	6	8
Propionibacterium acnes	9	3	6
Escherichia coli ^b	5	1	4
Pseudomonas aeruginosa ^a	2	0	2
Enterococcus faecalis ^a	2	0	2
Enterobacteriaceae	2	0	2
Morganella morganii	1	0	1
Proteus mirabilis	1	0	1
No growth	4	1	3

a Difficult-to-treat microorganisms as defined by Zimmerli et al. (2004) and Trampuz and Zimmerli (2005).

b 1 Escherichia coli strain and 2 Staphylococcus aureus strains were small-colony variants (Sendi et al. 2006) that were also defined as difficult-to-treat (see above).

Figure 3. Kaplan-Meier survival with revision for infection as endpoint after 7 years was 100% for 1-stage exchange and 94% (95% CI: 87–100) for 2-stage exchange. There was no statistically significant difference between the groups (p = 0.2).

Figure 4. Kaplan-Meier survival with revision for aseptic stem loosening as endpoint after 7 years was 96% (95% CI: 90–100) for 1-stage exchange and 97% (95% CI: 92–100) for 2-stage exchange. There was no statistically significant difference between the groups (p = 0.8).

Figure 5. Kaplan-Meier survival with revision for any reason as endpoint after 7 years was 96% (95% CI: 90–100) for 1-stage exchange and 87% (95% CI: 77–96) for 2-stage exchange. There was no statistically significant difference between the groups (p = 0.3).

Table 2. Distribution of acetabular and femoral defects

	Total no.	1-stage	2-stage
Acetabular defects, classification according to Paproski et al. (1994)
0	26	17	9
1	8	3	5
2A	17	4	13
2B	4	1	3
2C	20	4	16
3A	5	0	5
3B	1	0	1
Femoral defects, classification according to Pak et al. (1993)
0	3	2	1
I	7	4	3
II	39	20	19
IIIA	30	3	27
IIIB	2	0	2
IV	0	0	0

Table 3. Summary of the literature concerning 1- and 2-stage cementless revisions in PJI

	N	Follow-up, years	Implant retention (%)	Bone grafts
1-stage
Bori et al. 2014	24	2.7	96	2 cases
Ilchmann et al. 2015	39	6.6	100
Winkler et al. 2008	37	4.4	92	a
Yoo et al. 2009	12	7.2	83	8 cases
Zeller et al. 2014	157	3.5	95
2-stage
Dieckmann et al. 2014	43	3.9	93	ND
Fink et al. 2009	36	2.9	100	ND
Kim et al. 2011	294	10.4	98	Yes
Koo et al. 2001	22	3.4	95	ND
Masri et al. 2007	29	> 2	90	ND
Neumann et al. 2012	44	5.6	98	ND
Romano et al. 2011	20	4.7	95	ND

a Impregnated impaction grafting

ND: No data

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