Chronic infection following total hip arthroplasty: Any role for ilizarov?

Abstract

Context: Treatment of chronic infection following total hip arthroplasty (THA) poses challenges in revision and in salvage surgeries such as resection arthroplasty. Aims: We evaluated the results and role of Ilizarov fixator in resection and revision for infected hip arthroplasty. Settings and Design: This was a retrospective descriptive study. Subjects and Methods: We reviewed 73 patients treated between 2004 and 2014 with follow-up of 4.3 ± 1.8 years. Forty-three patients underwent two-stage revision (with interim antibiotic spacer), whereas 30 patients underwent Ilizarov-assisted resection arthroplasty. We supplemented eight patients with unstable spacers with Ilizarov apparatus. We evaluated patients for recurrence of infection, hip function and stability. Statistical Analysis Used: Descriptive methods. Results: Eight patients with Ilizarov supplementation of spacer went on to have stable hips. Two patients who had intraoperative stable spacers developed spacer dislocation. Pseudarthroses in resection group remained stable in all patients except one who had early dislocation which we managed by realigning the fixator. There was no mortality. We eradicated infection in 68/73 patients (93.2%). We converted three patients of spacer application to resection arthroplasty. The mean Harris Hip Score improved from preoperative value of 43.3 ± 18.8 to 67 ± 10.4 (81.4 ± 9 in revision and 52.6 ± 11.8 in resection groups). Conclusions: We recommend Ilizarov supplementation in temporary spacers with intraoperative instability. Ilizarov fixator improves stability and helps mobilization of resection arthroplasty and staged revision using spacers done for chronic post-THA infections.

Keywords

• Ilizarov
• postarthroplasty infection of hip
• resection arthroplasty hip
• two-stage revision arthroplasty hip