Treatment of Infected Hip Arthroplasty

The clinical outcomes of a consecutive series of deep total joint infections treated with a prosthesis retaining protocol were reviewed. The treatment of deep periprosthetic joint infections is challenging. In recent years, two-stage exchange arthroplasty has emerged as the gold standard for successful elimination of infection. With success rates averaging 82% to 96%, this treatment method has both the highest and most consistent rate of infection eradication. Another alternative in the treatment of the deep periprosthetic infection is the single-stage exchange arthroplasty. Successful eradication of infection after single-stage exchange arthroplasty has been reported to average from 60% to 83% after total hip infections. While both the single and two-stage exchange arthroplasty are viable treatment options, they are associated with negative factors such as they are time consuming, expensive, and may entail a 6- to 12-week period with a minimally functioning extremity after prosthesis removal. This paper reports the general principles of management, the treatment of acute infection occurring in the postoperative period or later, and the treatment of chronic infection by exchange arthroplasty or resection arthroplasty.

[1]  I. Stockley,et al.  The use of two-stage exchange arthroplasty with depot antibiotics in the absence of long-term antibiotic therapy in infected total hip replacement. , 2008, The Journal of bone and joint surgery. British volume.

[2]  Brent T. Wise,et al.  Antibiotic susceptibility of bacteria infecting total joint arthroplasty sites. , 2006, The Journal of bone and joint surgery. American volume.

[3]  T. Schmalzried.  The infected hip: telltale signs and treatment options. , 2006, The Journal of arthroplasty.

[4]  Mel S. Lee,et al.  Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. , 2004, The Journal of bone and joint surgery. American volume.

[5]  E. Salvati,et al.  Effective bactericidal activity of tobramycin and vancomycin eluted from acrylic bone cement , 2001, Acta orthopaedica Scandinavica.

[6]  T P Schmalzried,et al.  Limited Role of Direct Exchange Arthroplasty in the Treatment of Infected Total Hip Replacements , 2000, Clinical orthopaedics and related research.

[7]  S. Odum,et al.  Articulating Versus Static Spacers in Revision Total Knee Arthroplasty for Sepsis , 2000, Clinical orthopaedics and related research.

[8]  B. Morrey,et al.  Treatment of Infection with Débridement and Retention of the Components following Hip Arthroplasty* , 1998, The Journal of bone and joint surgery. American volume.

[9]  H. Amstutz,et al.  Direct-Exchange Arthroplasty for the Treatment of Infection after Total Hip Replacement. An Average Ten-Year Follow-up* , 1998, The Journal of bone and joint surgery. American volume.

[10]  B. Masri,et al.  Treatment of Infection Associated with Segmental Bone Loss in the Proximal Part of the Femur in Two Stages with Use of an Antibiotic-Loaded Interval Prosthesis* , 1998, The Journal of bone and joint surgery. American volume.

[11]  B. Masri,et al.  Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Treatment of Infection at the Site of Total Hip Replacement*† , 1997 .

[12]  B. Espehaug,et al.  Antibiotic prophylaxis in total hip arthroplasty , 1997 .

[13]  Chin-En Chen,et al.  Reimplantation of Infected Hip Arthroplasties Using Bone Allografts , 1997, Clinical orthopaedics and related research.

[14]  B. Masri,et al.  Elution characteristics of vancomycin and tobramycin combined in acrylic bone-cement. , 1996, The Journal of arthroplasty.

[15]  R. Gustilo,et al.  Infection after Total Hip Arthroplasty. A Study of the Treatment of One Hundred and Six Infections* , 1996, The Journal of bone and joint surgery. American volume.

[16]  A. Hanssen,et al.  Infection after total hip arthroplasty. Past, present, and future. , 1995, The Journal of bone and joint surgery. American volume.

[17]  B. Wroblewski,et al.  One-stage revision of infected total hip replacements with discharging sinuses. , 1994, The Journal of bone and joint surgery. British volume.

[18]  Garvin Kl.  Two-stage reimplantation of the infected hip. , 1994 .

[19]  P. Pellicci,et al.  Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol. , 1994, Clinical orthopaedics and related research.

[20]  A. Hanssen,et al.  The use of porous prostheses in delayed reconstruction of total hip replacements that have failed because of infection. , 1994, The Journal of bone and joint surgery. American volume.

[21]  T. Schmalzried,et al.  Etiology of deep sepsis in total hip arthroplasty. The significance of hematogenous and recurrent infections. , 1992, Clinical Orthopaedics and Related Research.

[22]  D. Berry,et al.  The use of bone allografts in two-stage reconstruction after failure of hip replacements due to infection. , 1991, The Journal of bone and joint surgery. American volume.

[23]  G. Gudmundsson,et al.  Prophylaxis with systemic antibiotics versus gentamicin bone cement in total hip arthroplasty. A five-year survey of 1688 hips. , 1990, Clinical orthopaedics and related research.

[24]  P. Norman,et al.  Deep infection of cemented total hip arthroplasties caused by coagulase-negative staphylococci. , 1989, The Journal of bone and joint surgery. British volume.

[25]  D. Ilstrup,et al.  Two-stage reconstruction of a total hip arthroplasty because of infection. , 1989, The Journal of bone and joint surgery. American volume.

[26]  B. Wroblewski.  One‐stage Revision of Infected Cemented Total Hip Arthroplasty , 1986, Clinical orthopaedics and related research.

[27]  Wroblewski Bm.  One-stage revision of infected cemented total hip arthroplasty. , 1986 .

[28]  Vree Tb,et al.  Gentamicin-PMMA beads. Pharmacokinetic and nephrotoxicological study. , 1986 .

[29]  L. Trachtenberg,et al.  In vitro characteristics of tobramycin-PMMA beads: compressive strength and leaching. , 1985, Orthopedics.

[30]  R. H. Turner,et al.  Medical and surgical treatment of the septic hip with one-stage revision arthroplasty. , 1982, Clinical orthopaedics and related research.

[31]  H W Buchholz,et al.  Management of deep infection of total hip replacement. , 1981, The Journal of bone and joint surgery. British volume.

[32]  E. Dingeldein,et al.  The release of gentamicin from polymethylmethacrylate beads. An experimental and pharmacokinetic study. , 1978, The Journal of bone and joint surgery. British volume.

[33]  J. Nelson.  Deep infection following total hip arthroplasty. , 1977, The Journal of bone and joint surgery. American volume.

[34]  E. Lautenschlager,et al.  Antibiotic-impregnated acrylic bone cement. , 1976, The Journal of bone and joint surgery. American volume.

[35]  M. B. Coventry,et al.  Complications of total hip arthroplasty treated by reoperation. , 1975, The Journal of bone and joint surgery. American volume.

[36]  H. Buchholz,et al.  [Depot effects of various antibiotics mixed with Palacos resins]. , 1970, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[37]  I. Stockley,et al.  The use of vancomycin-impregnated cement beads in the management of infection of prosthetic joints. , 2002, The Journal of bone and joint surgery. British volume.

[38]  B. Wroblewski,et al.  One stage revision arthroplasty of the hip for deep gram negative infection , 1996, International Orthopaedics.

[39]  I. Jou,et al.  Two-stage cementless revision THR after infection. 5 recurrences in 40 cases followed 2.5-7 years. , 1996, Acta orthopaedica Scandinavica.

[40]  W. Capello,et al.  Surgical treatment of the infected hip implant. Two-stage reimplantation with a one-month interval. , 1994, Clinical orthopaedics and related research.

[41]  K. Garvin.  Two-stage reimplantation of the infected hip. , 1994, Seminars in arthroplasty.

[42]  R. Merkow,et al.  The Use of Tobramycin-Impregnated Polymethylmethacrylate Beads in the Therapy of Deep Bone and Joint Infections , 1987, Journal of Orthopaedics and Trauma.

[43]  A. Gristina,et al.  Current concepts review. Total joint replacement and sepsis. , 1983, The Journal of bone and joint surgery. American volume.