The Treatment of Infected Total Hip Arthroplasty: Report of 12 Cases

Han, Kil Joo; Yu, Chang Mu; Lee, Suck Ha; Lee, Seong Jong; Kim, Taik Seon; Shim, Jae Ik; Shon, Won Yong

Abstract

Deep infection is the most serious complication of total hip arthroplasty with difficulty to treat and occasionally results into catastrophic consequences. The treatment methods are antibiotics, incision & drainage of the hip, debridement & modified Girdlestone resection arthroplasty, one stage revision to total hip arthroplasty, two stage revision and hip disarticulation. The purpose of this report is to consider the treatment of the infected total hip arthroplasty. Since 1979, we have treated 12 cases of infected arthroplasty including 6 cases from other hopital. Duration of interval between primary hip arthroplasty and diagnosis of infection were average 42,4 months(minimum 2 months to maximum 16 years). The results were as follows; 1. The incidence rate of the infected total hip arthroplasty was 1.3%. 2. By Fitzgerald classification, 2 cases were in acute stage, 6 cases in delayed stage and 4 cases in late stage. 3. The causative organisms were coagulase negative Staphylococcus aureus in 6 cases, Staphylococcus hemolyticus in 2 cases, Pseudomonas in 1 case and negative culture in 3 cases. 4. Increased uptake on Bone Scan in all 12 cases and increased ESR ranged from 28mm/hr to 82mm/hr. 5. Our treatment methods were secondary revision to total hip arthroplasty with cement bead insertion in 4 cases, primary revision in 1 case, incision & drainage of hip in 1 case, debridement & modified Girdlestone resection arthroplasty in 2 cases and hip disarticulation in 2 cases. And the rest 2 cases have been followed up after modified Girdlestone resection arthroplasty because of the remained infection. In our experience, two stage revision to total hip arthroplasty with antibiotics mixed cement bead was more useful in the treatment of the infected total hip arthroplasty.