Two-Stage Total Hip Arthroplasty for Primary Advanced Septic Arthritis of the Hip in Adults

Abstract

Background. Comparing the outcomes of debridement and total hip arthroplasty (THA) with antibiotic-loaded spacer implantation and subsequent THA for the treatment of patients affected by primary advanced septic arthritis (SA) of the hip in adults. Methods. All of the 20 patients (20 hips) underwent two-stage surgery. Nine patients were submitted to surgical debridement first and then THA (group 1), while 11 patients were treated with antibiotic-loaded spacer and subsequent THA (group 2). Patients were evaluated based on the recurrence of infection, Harris hip score, visual analogue scale (VAS) pain score, and leg length discrepancy. Results. No cases of infection, deep vein thrombosis, death, and loosening of the hip prosthesis were observed during follow-up. The mean follow-up time was $29.09\pm 10.80$ months in group 1 and $28.22\pm 14.80$ months in group 2. Before the THA surgery, the mean leg length discrepancy was $2.80\pm 2.03$  cm in group 1 and $0.50\pm 0.23$  cm in group 2 ( $P<0.05$ ). In the latest follow-up, the Harris hip scores of patients were $90.33\pm 4.85$ in group 1 and $94.36\pm 2.34$ in group 2 ( $P<0.05$ ), respectively. There was no statistically significant difference in the VAS pain score of the hip between the two groups ( $P>0.05$ ). Conclusions. Debridement and antibiotic-loaded spacer and subsequent THA were effective in eradicating the infection for advanced SA. However, antibiotic-loaded spacer and subsequent THA was superior for effectively maintaining the length of the lower limb and function of the hip.