[Two-stage procedure to exchange septic total hip arthroplasties with late periprosthetic infection. Early results after implantation of a reverse modular hybrid endoprosthesis].
BACKGROUND
Between January 2001 and January 2005 we performed the exchange of infected total hip arthroplasties in 40 cases.


METHODS
We applied a two-stage procedure when implant salvage was not possible. Our treatment algorithm included complete removal of the infected material, thorough débridement, and repeated revisions until cultures were negative. We then implanted a cemented acetabular polyethylene cup with specific antibiotic addition and a cementless modular stem (reverse modular hybrid endoprosthesis). Appropriate intravenous and oral antibiotic therapy was prescribed.


RESULTS
A total of 18 women and 22 men (age 48-86 years) were followed up for 4-48 months (mean: 12 months). Up to now 38 have remained infection free; in two cases the treatment failed and a resection arthroplasty had to be performed. There were eight complications intraoperatively (shaft fractures); four of them were treated conservatively and four needed additional stabilization. The mean hip score improved from 21 points initially to 81 points at the last examination. All details are listed in table form. Two-stage revision hip arthroplasty for infection using the inverse modular hybrid technique seems to be a safe and reliable method. Further investigation and a larger number of patients are necessary to confirm these preliminary results.
Walter
G
G
Abteilung für Septische Chirurgie, BG-Unfallklinik, Friedberger Landstrasse 430, 60389 Frankfurt/M. gerhard.walter@bgu-frankfurt.de
Bühler
M
M
Hoffmann
R
R
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000601:surgery*
D000900:Anti-Bacterial Agents