[Treatment of infected total prosthesis arthroplasty of the hip joint]

Abstract

With a median follow-up of 8 (1-13) years in our series, we are familiar with the entire courses in 62 infected hip arthroplasties, treatment starting between 1980 and 1986. The primary treatment was débridement with suction/irrigation in 6 cases, one-stage replacement of the prosthesis in 32 occasions and two-stage replacement in 23 cases. Only one definitive Girdlestone procedure was done. With further operations successful healing was finally achieved in all 62 hips. In 74% healing was primary, this being the case in 91% (10/11) of early and 71% (36/51) of late infections. Device-retaining procedures can be tried, particularly in early infections with low-virulence bacteria and a stable implant. One-stage revisions can be done in early and late low-virulence infections with loosening of components if bone and soft tissue are in good condition. In all other situations a two-stage procedure is recommended. As a rule, reimplantation can be done within 2 weeks. In cases with recurrent infection, replacement should be delayed for several months. As an alternative, several open débridements with reimplantation of a new prosthesis after 2 weeks can be considered. Girdlestone resection arthroplasty should be avoided whenever possible. Antimicrobial treatment is of great importance: it should be maintained for at least 3 months and in any case until 1 month after normalization of laboratory and clinical signs of infection.