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Journal of Long-Term Effects of Medical Implants

Publicou 4 edições por ano

ISSN Imprimir: 1050-6934

ISSN On-line: 1940-4379

SJR: 0.184 SNIP: 0.485 CiteScore™:: 1.1 H-Index: 39

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Decision Matrix-Guided Treatment of Infected Hip Resurfacing

Volume 30, Edição 2, 2020, pp. 91-102
DOI: 10.1615/JLongTermEffMedImplants.2020035511
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RESUMO

Infection can nullify the benefits of a successful hip resurfacing arthroplasty (HRA). Even with infection, it may be feasible to meet a patient's desire to retain the implant. The author reviewed records of 301 patients with infected hip resurfacing. Patients expressed their treatment preference using a decision matrix that considered treatment efficacy, consequences of treatment failure, probability of infection worsening, and treatment side effects. Patient interviews were analyzed to determine their experience with treatment. Treatment alternatives were (1) no surgery, oral antibiotics, and local incision care; (2) surgical debridement, IV antibiotics, and implant retention; (3) one-stage explantation, IV antibiotics, and reimplantation generally with conversion to total hip replacement; and (4) two-stage reimplantation with conversion to total hip replacement. Mean follow-up was 9 years (range, 2-34). Pretreatment qualitative themes found that some patients believed their early infection symptoms were not validated, leading to diagnostic delays. During treatment, themes centered on mobility and lifestyle limitations for those receiving revision surgery. Posttreatment themes were reduced function following revision compared to pretreatment function. Of the 301 patients, 199 (66%) had nonoperative care, with remission for 169 (85%); 40 (13%) had one-stage reimplantation and 36 (90%) had infection remission; 16 (5%) had two-stage reimplantation with remission in 14 (87%); and 46 (16%) had debridement and implant retention, with remission for 38 (83%). The matrix showed that patients with infected HRA preferred nonoperative care, which was successful for 85%. Qualitative themes found less patient distress with nonoperative treatment and the greatest patient distress with two-stage revision.

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CITADO POR
  1. Girard Julien, Letter to the Editor: Is the Survivorship of Birmingham Hip Resurfacing Better Than Selected Conventional Hip Arthroplasties in Men Younger Than 65 Years of Age? A Study from the Australian Orthopaedic Association National Joint Replacement Registry, Clinical Orthopaedics & Related Research, 479, 7, 2021. Crossref

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