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24. Long-Term Outcomes of Staged Revision Surgery for Chronic Periprosthetic Joint Infection of Total Hip Arthroplasty.

Author

Day, Christopher W., Costi, Kerry, Pannach, Susan, Atkins, Gerald J., Hofstaetter, Jochen G., Callary, Stuart A., Nelson, Renjy, Howie, Donald W., and Solomon, Lucian B.

Subjects
*REOPERATION, *TOTAL hip replacement, *JOINT infections, *DEATH rate, *TREATMENT effectiveness
Abstract

Periprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty. Staged revision surgery is considered effective in eradicating PJI. We aimed to determine the rate of infection resolution after each stage of staged revision surgery (first stage, repeat first stage, second stage, excision arthroplasty, and reimplantation) and to assess functional outcomes and the mortality rate at ten years in a consecutive series of 30 chronic PJI of total hip arthroplasties. Infection resolution was defined as no clinical nor laboratory evidence of infection at 24 months after the last surgery and after a minimum of 12 months following cessation of antimicrobial treatment. Four patients died within 24 months of their final surgery. Nineteen patients, 73% (worst-case analysis (wca) 63%), were infection free after 1 surgery; 22 patients, 85% (wca 73%), were infection free after 2 surgeries; and 26 patients, 100% (wca 87%), were infection free after three and four surgeries. The median Harris Hip Score was 41 prior to first revision surgery and improved to 74 at twelve months and 76 at ten years after the final surgery. Thirteen patients died at a mean of 64 months from first revision, giving a mortality rate of 43% at ten years, which is approximately 25% higher than that of an age-matched general population. The results show that with repeated aggressive surgical treatment, most PJIs of the hip are curable. Ten years after successful treatment of PJI, functional outcomes and pain are improved and maintained compared to before initial surgery, but this must be balanced against the high 10-year mortality. Level of evidence: cohort studies. [ABSTRACT FROM AUTHOR]

Published
2022
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25. The Long-Term Wear of Retrieved McKee-Farrar Metal-on-Metal Total Hip Prostheses

Author

Chinnia Subramanian, Mark J. Pearcy, Richard W. McCalden, Donald W. Howie, Namal S. Nawana, Kerry Costi, University of South Australia, Subramanian, Chinnia, Howie, Donald, McCalden, Richard, Nawana, Namal, Costi, Kerry, and Pearcy, Mark

Subjects
Adult, Male, Reoperation, 090302 Biomechanical Engineering, wear, metal, Surface Properties, medicine.medical_treatment, Total hip replacement, Polishing, Prosthesis Design, Prosthesis, Sphericity, Postoperative Complications, medicine, Humans, Orthopedics and Sports Medicine, hip arthroplasty, Device Removal, Aged, Aged, 80 and over, Orthodontics, electron microscopy, business.industry, Metallurgy, Abrasive, Middle Aged, on, Survival Analysis, Biomechanical Phenomena, Equipment Failure Analysis, Hip arthroplasty, Microscopy, Electron, Scanning, Female, Chromium Alloys, Hip Prosthesis, prosthesis, business, Total hip arthroplasty
Abstract

Twenty-four cobalt-chrome alloy McKee-Farrar matching acetabular and femoral components were retrieved at revision total hip arthroplasty. The average time in situ was 16 years. Wear and loss of sphericity was very low. Polishing wear (type 1), fine abrasive (type 2), multidirectional dull abrasive (type 3), and unidirectional dull abrasive wear (type 4) of the articulating surfaces were identified. The mean percent area of femoral heads occupied by types 2, 3, and 4 wear was 18%, 5%, and 2%, respectively. There was no association between the type and distribution of wear and the time in situ. Impingement damage was evident on 9 implant pairs. The extent and types of wear described in this paper will be useful when analyzing the patterns of surface damage of newer designs of metal-on-metal articulations.

Published
2005

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