Treatment of an infected total hip replacement with the PROSTALAC system. Part 1: Infection resolution.
BACKGROUND
Infection after total hip replacement (THR) is a serious medical complication with significant negative ramifications for both the patient and the health care system. The prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) was designed to treat the joint infection while maintaining functional movement in the hip.


METHODS
We identified 28 patients treated for infected THR with the PROSTALAC system, by retrospective chart review. Preoperative and intraoperative cultures were taken to identify the causative organism. After PROSTALAC insertion, patients underwent at least 6 weeks of intravenous (IV) antibiotics. Prior to undergoing posttreatment cultures, patients were required to be antibiotic-free for a minimum of 6 weeks, with normal laboratory values. We defined resolution infection as retention of a joint prosthesis for a minimum of 2 years.


RESULTS
Infection was identified in 28 patients in either the joint aspirate or intraoperative cultures. Of these patients, 2 failed to clear infection, requiring repeat PROSTALAC insertion. Two additional patients had positive 48-hour cultures post-second stage, treated with additional IV antibiotics. Retention of the post-PROSTALAC prosthesis is 100% at 2 years.


CONCLUSIONS
PROSTALAC has acceptable infection resolution outcomes and appears effective for treating infected THR.
Scharfenberger
Angela
A
University of Alberta Hospital, Edmonton, Alta.
Clark
Marcia
M
Lavoie
Guy
G
O'Connor
Greg
G
Masson
Edward
E
Beaupre
Lauren A
LA
D000180:Acrylic Resins; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip; D001843:Bone Cements; D003646:Debridement; D020878:Device Removal; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy; D014031:Tobramycin / Q000008:administration & dosage; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage
D000180:Acrylic Resins; D000900:Anti-Bacterial Agents; D001843:Bone Cements; D014640:Vancomycin; D014031:Tobramycin