The importance of clinical and radiological evaluation in the diagnosis and treatment of periprosthetic joint infection following hip arthroplasty

Abstract

Introduction Infection after total joint replacement is a severe complication that accounts for 40 % with reoperations. An in-depth study from a European country measured the direct costs due to revision of infected hip prosthesis and calculated these at just over €32000 per patient. This represents a substantial need for the timely diagnosis of infection. Material and methods Clinical and radiological assessments were performed for 73 patients with periprosthetic joint infection after total hip replacement. Of them, 43 (59 %) patients underwent two-stage revision hip joint arthroplasty using preformed spacer and 30 (41 %) patients had resection arthroplasty with application of the Ilizarov external fixator. Results Clinical and radiographic findings used as the basic diagnostic tool for prosthetic joint infection and the choice of the most reliable surgical treatment could provide remission of purulent inflammatory process in 85 to 89 % of the cases and improve functional condition of the limb by at least 24 %. Discussion Patients with periprosthetic joint infection after hip arthroplasty constitute a challenging clinical group with the need of comprehensive clinical and instrumental examination with clinical and radiological assessments being an integral part in the diagnosis of prosthetic joint infection. Radiographs and fistulograms are practical in evaluating a clinical situation, identifying periprosthetic joint infection to make careful preoperative assessment and planning. At the same time, the use of the W.G. Paprosky femoral deficiency classification is useful in determining a volume of surgical debridement, choosing an optimal treatment of periprosthetic joint infection and hardware for the performance.