BACKGROUND The efficacy of partial retention of well-fixed components during two-stage exchange for chronic total hip arthroplasty (THA) infection has remained unknown. METHODS A total of 14 patients with chronic infected THA were treated with damage control two-stage revision, including selective retention of the well-fixed femoral or acetabular component, aggressive debridement, antibiotic-laden cement spacer, antibiotic therapy, and delayed reimplantation. Indications for this treatment included chronic infected THAs with ingrown femoral or acetabular component and positive microbial growth with sensitive antibiotics. We excluded patients with acute infection; negative microbial growth; positive pathogen with high-virulence bacterial infections and multiple drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus, fungi, and Mycobacterium tuberculosis; sinus formation; a prior failure for periprosthetic joint infection (PJI) treatment; and obvious bone resorption in both femoral and acetabulum side. During the study period, this represented 3.3% (14/425) of the patients treated for infected THA. Minimum follow-up was three years. None of the 14 patients in this series were lost to follow-up. Successful treatment was defined according to a modified Delphi-based international multidisciplinary consensus. RESULTS No repeated debridement and recurrence of infection occurred during the study period; no patient need chronic antibiotic suppression. Successful treatment of chronic PJI was achieved in all patients. Despite the high peri-operative complication rate, no severe consequences were observed. The mean Harris Hip Score was 86 (range, 82-92; SD, 3.3). CONCLUSIONS The selective partial implant retention two-stage revision for chronic PJI may be a treatment option in properly selected patients with low virulence bugs.

中文翻译：

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慢性感染全髋关节置换术两阶段置换中的部分植入物保留。


背景 在慢性全髋关节置换术（THA）感染的两阶段交换过程中，部分保留固定良好的部件的效果仍然未知。方法对14例慢性感染THA患者进行损伤控制两期翻修治疗，包括选择性保留固定良好的股骨或髋臼假体、积极清创、抗生素骨水泥垫片、抗生素治疗和延迟再植。这种治疗的适应症包括慢性感染的股骨或髋臼组件向内生长的THA以及敏感抗生素导致的微生物阳性生长。我们排除了急性感染患者；微生物负增长；阳性病原体为高毒力细菌感染和多重耐药菌，如耐甲氧西林金黄色葡萄球菌、真菌、结核杆菌等；窦形成；既往假体周围感染（PJI）治疗失败；股骨侧和髋臼侧骨吸收明显。在研究期间，这占接受感染 THA 治疗的患者的 3.3% (14/425)。最短随访时间为三年。该系列中的 14 名患者均未失访。成功治疗的定义是根据经过修改的基于德尔菲的国际多学科共识。结果 研究期间未发生重复清创及感染复发情况；没有患者需要长期抑制抗生素。所有患者的慢性 PJI 均获得成功治疗。尽管围手术期并发症发生率很高，但没有观察到严重后果。平均 Harris 髋关节评分为 86（范围，82-92；SD，3.3）。 结论 对于正确选择的低毒力细菌患者，选择性部分种植体保留两阶段翻修治疗慢性 PJI 可能是一种治疗选择。