One-Stage Revision Using Cementless Reconstruction for Chronically Infected Total Hip Arthroplasty: An Average of 11 Years of Follow-Up.

Abstract

Although interest in one-stage revision has increased in recent years, long-term follow-up reports remain notably scarce. This study aimed to present the 11-year outcomes of cementless one-stage revision for chronically infected total hip arthroplasty (THA), including infection-free survivorship, radiographic and clinical outcomes, and complications. A retrospective analysis conducted between 2010 and 2016 included 126 patients who had chronically infected THA and underwent one-stage revision using cementless reconstruction. Kaplan-Meier survival analysis was used to assess postoperative survival, while Cox regression analysis identified risk factors for reinfection. Updated postoperative imaging, Harris Hip Scores, and complications were recorded. Successful infection treatment was defined as the absence of clinical symptoms of infection during follow-up. During a mean follow-up period of 11 years (range, eight to 14), 16 patients experienced infection recurrence, resulting in a 10-year infection-free survival rate of 85.4%. Cox regression analysis identified age ≥ 65 years (HR [hazard ratio] 3.0, 95% CI [confidence interval] 1.2 to 8.6; P = 0.02) and American Society of Anesthesiologists grade III (HR 3.1, 95% CI 1.1 to 8.1; P = 0.03) as significant risk factors for reinfection. The presence of a sinus tract, prolonged operative time, culture-negative periprosthetic joint infection, methicillin-resistant pathogen infection, and prior surgery for infection were not associated with recurrence. Among the patients, two experienced recurrent dislocations and one had aseptic loosening, leading to a 10-year aseptic rerevision-free survival rate of 97.0%. The mean postoperative Harris Hip Scores at the latest follow-up was 77.9 points (range, 68.5 to 86.7; P < 0.001). Complications occurred in 26 patients (23.4%), and the 10-year reoperation-free survival rate was 78.7%. A one-stage revision using cementless reconstruction for infected THA demonstrated a favorable infection control rate and sustained satisfactory clinical outcomes. However, further studies with higher-level evidence are needed to validate these findings.