Hip Pelvis.  2017 Mar;29(1):35-43. 10.5371/hp.2017.29.1.35.

Acute Delayed or Late Infection of Revision Total Hip Arthroplasty Treated with Debridement/Antibiotic-loaded Cement Beads and Retention of the Prosthesis

• Chang JD
• Kim IS
• Lee SS
• Yoo JH

• KMID: 2371766
• DOI: http://doi.org/10.5371/hp.2017.29.1.35

Abstract

PURPOSE
The treatment of infected revision total hip arthroplasty (THA) is very challenging due to retained revision prosthesis, poor bone stock and soft tissue condition derived from previous revision surgeries, and comorbidities. The purpose of this study was to investigate the effectiveness and short-term outcomes of aggressive debridement and use of antibiotic-loaded cement beads with retention of the prosthesis for acute delayed or late infection of revision THAs.
MATERIALS AND METHODS
Ten consecutive patients with symptoms or signs of less than one-week evolution and well-fixed prostheses, were treated with this procedure and a postoperative course of organism-specific antibiotics for a minimum of 6 weeks. All hips presented with acute delayed or late infection of revision THAs. Patients with a mean age of 68.1 years (range, 59-78 years) underwent an average of 1.9 previous revision THAs (1-4) before the index surgery. The minimal follow-up was 2 years with a mean of 46.2 months (range, 24-64 months).
RESULTS
There were 8 cures (80.0%) and 2 failures with no mortality during the study period. The 2 failures involved the same and resistant bacteria implicated in the primary infection (methicillin-resistant Staphylococcus aureus and Prevotella oralis, respectively). The mean Harris hip score was 65.2 (range, 26-83) and the mean visual analogue scale was 2.6 (range, 1-4) at final follow-up.
CONCLUSION
With a favorable success rate and no mortality, our procedure may be considered a safe and effective alternative for the treatment of acute delayed or late infection of revision THAs with well-fixed prostheses.

Keyword

Debridement; Retention of the prosthesis; Antibiotic-loaded cement bead; Acute infection; Revision; Total hip arthroplasty

MeSH Terms

Anti-Bacterial Agents
Arthroplasty, Replacement, Hip*
Bacteria
Comorbidity
Debridement
Follow-Up Studies
Hip
Humans
Mortality
Prevotella
Prostheses and Implants*
Staphylococcus aureus
Anti-Bacterial Agents

Figure

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  Fig. 1 Anteroposterior radiograph of a 60-year-old man (case 5), showing acetabular cup loosening accompanied with osteolysis after three-time revision total hip arthroplasties (THAs) due to liner wear, osteolysis, or loosening for 20 years (A). (B) Periprosthetic joint infection developed 13 months after fourth revision THA, which was confirmed on the culture of hip aspirate. (C) Aggressive debridement and insertion of antibiotic-loaded cement beads with retention of prostheses, removal of some metal materials, and replacement of femoral head and acetabular liner, were performed. (D) Infection was controlled and left hip was well-functioned with Harris hip score of 80 points 26 months after 6-week antibiotics treatment and removal of cement beads with repetitive debridement, although there was some bony resorption on the lateral cortex of proximal femur.

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