Management of deep infection of total hip replacement

TLDR

Exchange operation is recommended as the treatment of choice for most deep infections involving a total hip replacement. The revision arthroplasty is a one‑stage procedure that excises soft tissue, removes the implant and cement, and replaces them with an implant cemented in Palacos R acrylic loaded with antibiotics, often supplemented by systemic antibiotics. In 583 patients over ten years, the first‑attempt success rate was 77 % and rose to 90 % after subsequent exchanges; morbidity was significant but acceptable, and failures were linked to specific organisms, delayed surgery, and inadequate cement antibiotic dosing.

Abstract

Exchange operation is recommended as the treatment of choice for most deep infections involving a total hip replacement. This revision arthroplasty comprises, in one stage, excision of soft tissue, removal of implant and cement, replacement with an appropriate implant using Palacos R acrylic cement loaded with an appropriate antibiotic and, more recently, systemic antibiotics. During our first 10 years without systemic antibiotics we have achieved an overall 77 per cent success rate from a first attempt in 583 patients and a 90 per cent success rate after subsequent exchange procedures. Morbidity is significant but acceptable. Success is defined as control of infection, no loosening, and useful function. The factors associated with failures include, in particular, specific infections (Pseudomonas group, Streptococcus group D, Proteus group, and Escherichia coli), delay in operation and inadequate antibiotic dosage in the cement.