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Clinical Trial
. 2018 Jan;100-B(1 Supple A):3-8.
doi: 10.1302/0301-620X.100B1.BJJ-2017-0626.R1.

Two-stage revision for the culture-negative infected total hip arthroplasty : A comparative study

M S Ibrahim  1 , H Twaij  2 , F S Haddad  3
Affiliations
Clinical Trial

Two-stage revision for the culture-negative infected total hip arthroplasty : A comparative study

M S Ibrahim et al. Bone Joint J. 2018 Jan.

Abstract

Aims: Periprosthetic joint infection (PJI) remains a challenging complication following total hip arthroplasty (THA). It is associated with high levels of morbidity, mortality and expense. Guidelines and protocols exist for the management of culture-positive patients. Managing culture-negative patients with a PJI poses a greater challenge to surgeons and the wider multidisciplinary team as clear guidance is lacking.

Patients and methods: We aimed to compare the outcomes of treatment for 50 consecutive culture-negative and 50 consecutive culture-positive patients who underwent two-stage revision THA for chronic infection with a minimum follow-up of five years.

Results: There was no significant difference in the outcomes between the two groups of patients, with a similar rate of re-infection of 6%, five years post-operatively. Culture-negative PJIs were associated with older age, smoking, referral from elsewhere and pre-operative antibiotic treatment. The samples in the culture-negative patients were negative before the first stage (aspiration), during the first-stage (implant removal) and second-stage procedures (re-implantation).

Conclusion: Adherence to strict protocols for selecting and treating culture-negative patients with a PJI using the same two-stage revision approach that we employ for complex culture-positive PJIs is important in order to achieve control of the infection in this difficult group of patients. Cite this article: Bone Joint J 2018;(1 Supple A)100-B:3-8.

Keywords: Culture negative infection; Hip arthroplasty; Total hip replacement; Two-stage revision.

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