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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慢性感染的全髋关节置换术的两阶段交换中保留部分植入物。

背景技术对于慢性全髋关节置换术（THA）感染，在两阶段交换期间部分固定固定组件的功效仍然未知。方法总共14例慢性感染THA的患者接受了损伤控制两阶段修复，包括选择性保留固定良好的股骨或髋臼组件，积极的清创术，载有抗生素的水泥垫片，抗生素治疗和延迟再植入。该治疗的适应症包括股骨或髋臼成分向内生长的慢性感染THA，以及敏感抗生素对微生物的生长呈阳性。我们排除了急性感染的患者。微生物负增长；阳性病原体，具有高毒力细菌感染和多种耐药菌，例如耐甲氧西林的金黄色葡萄球菌，真菌，和结核分枝杆菌；鼻窦形成；先前无法进行假体周围关节感染（PJI）治疗；股骨和髋臼侧骨吸收明显。在研究期间，这占接受THA感染治疗的患者的3.3％（14/425）。最低随访时间为三年。该系列的14例患者均未失去随访。根据改良的基于Delphi的国际多学科共识定义成功的治疗方法。结果在研究期间未发生再次的清创和感染复发。没有患者需要慢性抗生素抑制。所有患者均成功治疗了慢性PJI。尽管围手术期并发症发生率很高，但未观察到严重后果。哈里斯臀部平均得分为86（范围：82-92；标准差：3.3）。