Treatment of infected total hip arthroplasty with a 2-stage reimplantation protocol: update on "our institution's" experience from 1989 to 2003

J Arthroplasty. 2009 Oct;24(7):1051-60. doi: 10.1016/j.arth.2008.07.004. Epub 2008 Oct 9.

Abstract

Infection is a devastating complication of total hip arthroplasty (THA). This study aimed to determine whether 2-stage reimplantation is still effective for treating contemporary pathogens, including multidrug-resistant organisms. Records of all cases of infected THAs from 1989 to 2003 were reviewed for data on organism, presence of drug resistance, use of an antibiotic-impregnated spacer, type of reimplant, and success of treatment. Of the 87 protocol patients with 2 years of follow-up, 94.3% (82) underwent reimplantation. The original infection was eradicated in 80 of the 84 hips (78/82 patients), a success rate of 95%. All 21 multidrug-resistant infections were eradicated. There were no major differences in eradication rates when the period was split into 3 sections. These results support previous studies from our institution which demonstrated the effectiveness of a 2-stage reimplantation protocol with a standard 1:8 minimal bactericidal titer for treating infections after THA, including those due to methicillin-resistant organisms.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Arthroplasty, Replacement, Hip / instrumentation
  • Arthroplasty, Replacement, Hip / methods*
  • Combined Modality Therapy
  • Drug Delivery Systems
  • Drug Resistance, Bacterial / drug effects
  • Female
  • Follow-Up Studies
  • Hip Prosthesis / microbiology*
  • Humans
  • Klebsiella Infections / drug therapy
  • Male
  • Middle Aged
  • Prosthesis-Related Infections / drug therapy*
  • Prosthesis-Related Infections / surgery*
  • Reoperation / instrumentation
  • Reoperation / methods
  • Retrospective Studies
  • Staphylococcal Infections / drug therapy
  • Streptococcal Infections / drug therapy
  • Treatment Outcome
  • Young Adult

Substances

  • Anti-Bacterial Agents