[Risk factors for failed cleansing following periprosthetic delayed hip prosthesis infection]

Abstract

Background: Despite extensive cleansing concepts recurrent infections are relatively common especially for infections of hip prostheses. The aim of this retrospective study was to identify factors which hinder cleansing and facilitate recurrence.

Materials and methods: This study included 40 patients with periprosthetic delayed hip prosthesis infection who had been treated with the aim of infection cleansing between 2006 and 2008. Infection cleansing was carried out using a standardized treatment regimen with two and multiple phase reimplantation of the hip prosthesis following successful pathogen eradication. A clinical course follow-up was carried out after 2 years.

Results: Of the patients 18 (45%) were free of recurrence following successful eradication and reimplantation of the prosthesis and 5 (12.5%) suffered recurrence of infection after primarily successful revision prosthesis. In 17 patients (42.5%) treatment was switched to an alternative procedure primarily due to an uncleansable infection. In the group of patients with recurrent infections or untreatable infection, resistant pathogens could be detected significantly more often (p=0.001), in particular methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE) and highly resistant Pseudomonas. This group had a significantly worse American Society of Anesthesiologists (ASA) score (p = 0.002). The number of surgical interventions in this group was significantly higher.

Conclusions: A poorer general physical condition and resistant infectious pathogens are the main risk factors for recurrent infections following prosthesis reimplantation. Therefore, a different treatment concept should be used for polymorbid patients with resistant pathogen infections.