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Joint Arthroplasty in sequelae of septic arthritis of the hip: a therapeutic guideline to single or two stage procedures

Published in N°18 - July / August 2022
Article viewed 49 times

Joint Arthroplasty in sequelae of septic arthritis of the hip: a therapeutic guideline to single or two stage procedures

By Hernan del Sel, Fernando Lopreite, Facundo Bochatey, Fernando Tillet in category UPDATE
Dept. Orthopaedics & Trauma, Buenos Aires British Hospital, Perdriel 74, 1209 Buenos Aires, Argentina

Acute septic hip arthritis can nowadays be treated initially with arthroscopy or open debridement, followed by appropriate antibiotic therapy, but success or failure at preserving the joint are closely related to time elapsed since initiation of symptoms, with a cut-off at about 1 to 2 weeks (1).

Introduction

Acute septic hip arthritis can nowadays be treated initially with arthroscopy or open debridement, followed by appropriate antibiotic therapy, but success or failure at preserving the joint are closely related to time elapsed since initiation of symptoms, with a cut-off at about 1 to 2 weeks (1). In cases where the symptomatic period is prolonged and radiologic evidence of articular destruction is present, more radical surgery is needed. Articular resection is needed to eradicate infection, but it is associated with postoperative morbidities like leg length discrepancy, use of walking aids and use of pain medication. Historically, deep prosthetic infection was treated with resection arthroplasty (Girdlestone procedure), but the appearance of antibiotic loaded cement spacers allowed for better joint function with increased local antibiotic concentration. Better soft tissue tension permits full weight bearing and will facilitate the subsequent revision and articular reconstruction. (4,5,6) 

The most feared complication in hip arthroplasty after septic arthritis (active or quiescent) is recurrence of infection. A two-stage protocol, using a spacer and replacing it with a definitive prosthesis in a second stage once the infectious process is resolved, is considered...

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