title: Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol.
abstract: Forty-four patients (46 hips) with infected total hip arthroplasties were evaluated. They were entered into a protocol that included resection arthroplasty, six weeks of intravenous antibiotics which obtained a minimum postpeak serum bactericidal titer of 1:8, and possible reimplantation. Thirty-two of 46 hips (70%) were reimplanted. At an average of 40 months (range, 24-74 months) after reimplantation, infection recurred in three hips (9%). In two of the three recurrent infections, 1:8 bactericidal titers were not attained. Both of these hips were infected with gram-negative organisms. Minimum postpeak serum bactericidal titers of 1:8 were attained in 28 of 32 hips that were reimplanted, and only one of these hips (4%) had a recurrent infection (p = 0.035). The presence of retained cement after resection arthroplasty (ten hips) was not associated with recurrent infection. Fourteen hips (12 patients were not reimplanted as a result of a combination of factors, including inadequate bone stock, poor soft-tissue quality, and antibiotic resistance of the infecting organism. The treatment of an infected total hip arthroplasty with resection arthroplasty, six weeks of intravenous antibiotics that attains a minimum postpeak serum bactericidal titer of 1:8, and reimplantation can be an effective and safe treatment.
authors.affiliation: Department of Orthopaedic Surgery, UCLA School of Medicine 90024.
authors.forename: J R
authors.initials: JR
authors.lastname: Lieberman
authors.forename: G H
authors.initials: GH
authors.lastname: Callaway
authors.forename: E A
authors.initials: EA
authors.lastname: Salvati
authors.forename: P M
authors.initials: PM
authors.lastname: Pellicci
authors.forename: B D
authors.initials: BD
authors.lastname: Brause
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents