Uncemented total arthroplasty in old quiescent infection of the hip

We reviewed the outcomes of 24 cases (24 patients) of uncemented total hip arthroplasty done to treat secondary osteoarthritis due to quiescent previous infection. There were 16 men and eight women aged from 24 to 78 years (mean, 50 yr). Eight patients had proven or probable tuberculous infection and the other 16 patients had a past history of septic hip. The patients were followed for between 2.5 and 7 years (mean, 4.5 yr). According to the Harris hip rating system, 18 of the patients had excellent or good results. Three patients had a preoperative erythrocyte sedimentation rate of 40 mm/h or higher and had a positive bacterial culture. Two of these patients developed reinfection. The other 21 patients had a preoperative erythrocyte sedimentation rate less than 40 mm/h and no reinfection postoperatively. There were five complications other than infection: dislocation with ipsilateral femoral shaft fracture, intraoperative femoral fracture, cup loosening, periprosthetic osteolysis, and nonunion of the greater trochanter. Uncemented total arthroplasty for old quiescent infection of the hip should be considered if the preoperative erythrocyte sedimentation rate is normal and a course of prophylactic antituberculous therapy is given in patients with an old tuberculous hip.