To investigate the clinical efficacy and feasibility of antibiotic-loaded calcium sulfate in partial one-stage revision for chronic periprosthetic hip infection.

A retrospective study was conducted of the 33 patients who had undergone partial single-stage revision for chronic periprosthetic hip infection from January 2017 to January 2020 at the articular surgery department of the First Affiliated Hospital of Zhengzhou University.Inclusion criteria: patients with a diagnosis of PJI after THA and Tsukayama staging type IV were enrolled according to the American Musculoskeletal Infection Society (MSIS)diagnostic criteria; the patients who had revision surgery more than once, and intolerant of surgery were excluded. Thirteen males and 20 females were enrolled, aged from 55 to 81 years. The femoral stem or acetabular cup was selectively revised according to preoperative and intraoperative assessment of whether the prosthesis was firmly fixed and bone ingrowth. During revision surgery, the firm prostheses were retained, the acetabular linings and femoral headswere routinely replaced, thoroughly debridement was performed, andadequately brushed the exposed component. Antibiotic-loaded calcium sulfate were implanted together during the operation to construct a local drug delivery system. Regular follow-up was performed for infection control, Harris hip score (HHS), visual analogue score (VAS), short form health status score (SF-36) and complication occurrence. HHS, VAS and SF-36 scores were compared preoperatively, at six months and one year after the surgery using repeated measures ANOVA, with two-way comparisons using the Bonferroni method. Count data were compared using the Fisher exact probability test in a paired design.

The average age was (63±7)years, and all the patients were followed up for (32±17) months. One patient had signs of infection recurrence at six months after operation, and the infection symptoms were eliminated eight weeks after the re-operation. No sign of infection recurrence was found at the last follow-up, and the infection control rate was 97.0%. Twenty-six patients simply underwent the revision of the acetabular cup and retained the femoral handle, and seven patients only received the femoral handle revision surgery while the acetabular cups were retained. One year after revision surgery, HHS and SF-36 increased from(35.3±4.9)and(374.5±37.3)before the revision to(84.4±3.5)and (664.1±23.2)at one year after the revision. The VAS decreased from (6.9±1.4) preoperatively to (1.2±0.8) one year after revision surgery. There were statistically significant differences in the above items before revision surgery, six months after surgery and one year after surgery (F=1 099.116, 930.082, 242.621, all P<0.05), and there were statistically significant differences in pairwise comparisons at different time periods (all P<0.05).

Partial one-stage revision with antibiotic-loaded calcium sulfate may be used as an effective method for the treatment of chronic periprosthetic hip infection. It reduces surgical injury, improves hip function, and improves patients' quality of life, while effectively eradicating infection at the same time.