Between March 1984 and March 1989, thirty-four patients who had an
infection at the site of a cemented total hip prosthesis were managed with
resection arthroplasty and delayed implantation of a porous total hip
prosthesis without cement. The interval from the time of the resection
arthroplasty to the implantation of another prosthesis averaged eight
months (range, three to nineteen months). At an average of forty-seven
months (range, twenty-four to seventy-two months) after the reimplantation,
six patients (18 per cent) had recurrence of the infection. Patients who
had rheumatoid arthritis were at significantly higher risk for the
development of a recurrent infection (p < 0.01). Of the twenty-eight
patients who did not have a recurrent infection, six had definite
radiographic evidence of loosening of the femoral component at the latest
follow-up evaluation. For twenty-five of the twenty-eight patients,
sufficient data were available for calculation of the Mayo Clinic hip
score; only fourteen (56 per cent) of these patients had a satisfactory
functional outcome. The high (68 per cent) rate of complications and the
long-term durability of the prosthesis in these patients remain a concern.
The fact that 18 per cent of the patients had a recurrent infection
suggests that avoidance of the use of bone cement does not improve the rate
of resolution of infection after a delayed revision operation in patients
who have an infection following a total hip arthroplasty.