Revision of late periprosthetic infections of total hip endoprostheses: pros and cons of different concepts

Abstract

Many concepts have been devised for the treatment of late periprosthetic infections of total hip prostheses. A two-stage revision with a temporary antibiotic-impregnated cement spacer and a cemented prosthesis appears to be the most preferred procedure although, in recent times, there seems to be a trend towards cementless implants and a shorter period of antibiotic treatment. Because of the differences in procedure, not only between studies but also within studies, it cannot be decided which period of parenteral antibiotic treatment and which spacer period is the most suitable. The fact that comparable rates of success can be achieved with different treatment regimens emphasises the importance of surgical removal of all foreign materials and the radical debridement of all infected and ischaemic tissues and the contribution of these crucial procedures to the successful treatment of late periprosthetic infections.

Keywords: hip endoprostheses; periprosthetic infections.

Figure 1

Radiograph of a hip spacer of a 63year old man with late periprosthetic infection of the left hip

Figure 2

Radiograph two years after re-implantation of a cementless modular revision stem and a press-fit-cup