Problems, progress, and late outcome from the treatment of septic loosening of hip arthroplasty.
Background. The goal of this research was to evaluate problems and progress in the treatment of septic loosening of total hip replacements. These complications are typically the result of unfamiliarity with the risk factors, technical errors during surgery, improper management by physicians, or other factors, sometimes difficult to ascertain. The bacteria which cause injections are identified, and the methods used to control and manage infections are described.<br /> Material. The authors studied complicating infections in hip prostheses in 129 patients. This clinical material was divided into two groups: 31 patients with early infections and no indications of prosthesis loosening were assigned to Group I, while Group II included 98 patients with symptoms of late infection and signs of endoprosthesis loosening. Surgical treatment of early infection involved thorough debridement of the focus and many weeks of antibiotic therapy, both local and systemic.<br /> Results. In 21 cases complete healing was obtained. Due to recurrence of the infection, removal of the endoprosthesis was necessary in 10 cases. For the 98 patients with late infection, healing of the infection was noted in75 joints (76%) following removal of the focus of injection along with the endoprosthesis and cement. Poor outcome as measured by pain and persistent fistulae, was obtained in 11 joints (11,5%). Only in 12 patients (12,5%) was the endoprosthesis implanted without recurrence of the infection, obtaining, a good treatment outcome.<br /> Conclusions. The basic factors reducing the risk of causing septic loosening of the endoprosthesis are familiarity with the risk factors, the proper antibiotic prevention, the command of the requiste surgical skill and a high level of asepsis in the operating theater. The most commonly observed final outcome of treatment of the sequelae of septic loosening of the prosthesis is unstable pendent hip. Repeat implantation of an endoprosthesis can be considered in younger patient when healing of the infection has been confirmed clinically and biochemically.
Rapała
K
K
Klinika Ortopedii CMKP, Otwock.
Ozonek
W
W
Białecki
J
J
Lachowicz
W
W