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| Name | Class |
|---|---|
| Haukeland University Hospital | OTHER |
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The functional outcome and quality of life after treatment for an infected hip arthroplasty have been found to be significantly worse compared to an uncomplicated arthroplasty. However, the type of revision surgery chosen to treat the infection plays a role for the functional outcome. The concept of DAIR (debridement, antibiotics and implant retention) has been shown to yield god results with respect to infection control in cases of early infection with a stable implant and better functional results than a to-stage revision. In patients where infection control was achieved after just one DAIR procedure the functional outcome was comparable to an uncomplicated primary arthroplasty. However, it is not known if the operative approach used for the primary and revision surgery plays a role for the functional result after treatment of an infected total hip arthroplasty with DAIR. The project's aim is to investigate if the choice of the operative approach (transgluteal or posterior) for the primary hip replacement and the revision surgery has an influence on the functional result after debridement and implant retention for an infected total hip replacement.
Potential study participants will be identified in the Norwegian Arthroplasty Register. Patients who have been revised once for an infected total hip arthroplasty with debridement and implant retention and in whom either the transgluteal og posterior operative approach was used in both procedures will be selected. The potential participants will be contacted by letter. They will be asked for written informed consent and to fill out three questionnaires: the Hip Disability Osteoarthritis Score (HOOS), which also allows for the calculation of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), the EQ-5D (quality of life) and a questionnaire asking about confirmation that the patient only has been revised once for his/her infected arthroplasty, about limping, other complications (nerve injury, dislocation, reoperation for other causes than infection), if the infection is considered to have been eradicated and overall satisfaction. The data recorded in the Norwegian Arthroplasty Register will be used in a multiple linear regression analysis to evaluate if the surgical approach is an independent factor influencing the outcome measures.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Transgluteal approach to the hip joint | Patients who have been revised once for an infected total hip replacement with debridement and implant retention and in whom both the primary hip arthroplasty and the revision procedure were performed through a transgluteal approach. |
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| Posterior approach to the hip joint | Patients who have been revised once for an infected total hip replacement with debridement and implant retention and in whom both the primary hip arthroplasty and the revision procedure were performed through a posterior approach. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Transgluteal approach to the hip joint | Procedure | Operative approach to the hip joint where the abductors are partly detached from the greater trochanter and the hip joint is approached through the anterior part of the capsule. |
| Measure | Description | Time Frame |
|---|---|---|
| Function subscale score of the WOMAC | Function subscale score of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) | At minimum 1 year, on average 5 year follow-up from the DAIR procedure |
| Measure | Description | Time Frame |
|---|---|---|
| WOMAC score | Western Ontario and McMaster Universities osteoarthritis index score | At minimum 1 year, on average 5 year follow-up from the DAIR procedure |
| HOOS | Hip Disability Osteoarthritis Score |
| Measure | Description | Time Frame |
|---|---|---|
| Infection eradication | Patient reported eradication of the infection of their total hip arthroplasty. | At minimum 1 year, on average 5 year follow-up from the DAIR procedure |
Inclusion Criteria:
Exclusion Criteria:
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The potential study participant will be identified in the Norwegian Arthroplasty Register.
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| Name | Affiliation | Role |
|---|---|---|
| Asbjorn Aaroen, Professor | University Hospital, Akershus | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Akershus University hospital | Lørenskog | 1478 | Norway |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18453662 | Background | Cahill JL, Shadbolt B, Scarvell JM, Smith PN. Quality of life after infection in total joint replacement. J Orthop Surg (Hong Kong). 2008 Apr;16(1):58-65. doi: 10.1177/230949900801600115. | |
| 19336454 | Background | Byren I, Bejon P, Atkins BL, Angus B, Masters S, McLardy-Smith P, Gundle R, Berendt A. One hundred and twelve infected arthroplasties treated with 'DAIR' (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother. 2009 Jun;63(6):1264-71. doi: 10.1093/jac/dkp107. Epub 2009 Mar 31. |
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| Posterior approach to the hip joint | Procedure | Operative approach to the hip joint where the short external rotators are detached from the greater trochanter and the hip joint is approached through the posterior part of the capsule. |
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| At minimum 1 year, on average 5 year follow-up from the DAIR procedure |
| EQ-5D score | Quality of life score | At minimum 1 year, on average 5 year follow-up from the DAIR procedure |
| Limping | Patient reported limping on the side of the revised total hip replacement. | At minimum 1 year, on average 5 year follow-up from the DAIR procedure |
| Other complications | Patient reported nerve injury, dislocation, reoperation for other causes than infection. | At minimum 1 year, on average 5 year follow-up from the DAIR procedure |
| Overall satisfaction | Overall satisfaction with the revised total hip replacement assessed by questionnaire. | At minimum 1 year, on average 5 year follow-up from the DAIR procedure |
| 28385345 | Background | Grammatopoulos G, Kendrick B, McNally M, Athanasou NA, Atkins B, McLardy-Smith P, Taylor A, Gundle R. Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection-An 18-Year Experience. J Arthroplasty. 2017 Jul;32(7):2248-2255. doi: 10.1016/j.arth.2017.02.066. Epub 2017 Mar 6. |
| 33249901 | Derived | Pollmann CT, Gjertsen JE, Dale H, Straume-Naesheim TM, Dybvik E, Hallan G. Operative approach influences functional outcome after DAIR for infected total hip arthroplasty. Bone Joint J. 2020 Dec;102-B(12):1662-1669. doi: 10.1302/0301-620X.102B12.BJJ-2020-0501.R1. |