The infected hip: telltale signs and treatment options.
The diagnosis of deep infection after total hip arthroplasty may not be obvious. Mild pain may be the only symptom. Normal radiographs do not exclude infection. Screening blood tests include the erythrocyte sedimentation rate and the C-reactive protein. If either test is elevated with a painful total hip, aspiration of the joint is efficacious. Aspiration remains the cornerstone for the diagnosis and treatment of infection. Intraoperative frozen sections can also be of value in the diagnosis of infection; however, this method is dependent on tissue sampling. A 2-stage revision remains the criterion standard for treatment. An antibiotic-impregnated cement spacer can deliver a high concentration of antibiotic to the infected space, maintain soft tissue tension, and provide better function than a resection arthroplasty. Direct exchange is rarely indicated today.
Schmalzried
Thomas P
TP
Joint Replacement Institute at Orthopaedic Hospital, Los Angeles, California 90007, USA.
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D003646:Debridement; D006801:Humans; D010149:Postoperative Pain; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein