Hip implant infection. Treatment with resection arthroplasty and late total hip arthroplasty

Abstract

In 131 patients with an infected hip implant, treatment was surgical excision of the implant (resection arthroplasty) and delayed reconstruction with a total hip arthroplasty. Most of the patients had low-grade infections: only 5 percent had a temperature of 37.8 degrees C or higher and only 20 percent had wound drainage. Hip pain was the primary symptom of a deep infection in 90 percent. Staphylococci were the most frequently isolated causal organisms, recovered from deep tissue specimens in 84 patients. The hip was reconstructed six days to 32 years (mode, 429 days) after resection arthroplasty. At follow-up two to nine years after reconstruction, 88 percent of the 131 patients were free of infection. Recurrent sepsis was more common (p less than 0.05) in patients with incomplete acrylic cement removal or patients in whom reconstruction was performed less than 429 days after resection arthroplasty. Risk of recurrent sepsis was increased when gram-negative bacilli in pure or mixed cultures were found, but the difference was not statistically significant.