[Preservation of hip prosthesis with local surgical revision and creation of a fistula persistens : an option for palliative treatment of periprosthetic infection in old, polymorbid patients?].
BACKGROUND
The number of implanted hip prostheses is increasing constantly. At the same time the patients are becoming older and older. Thus, also patients with periprosthetic infections are older and therefore sicker. Uniform guidelines for the treatment of infected arthroplasties are controversial. Empirical studies show that the explantation of the original prosthesis and implantation of a revision may be the option with the greatest chance of success. These very aggressive procedures may overburden the old, polymorbid patient. The aim of this study was to ascertain whether or not keeping the hip prosthesis in combination with local debridement, formation of a permanent fistula and long-term administration of antibiotics is a possible option for the treatment of infected hip prostheses in old and polymorbid patients.


METHODS
Between 01.01.2004 and 28.01.2007, 12 patients with periprosthetic infection after hip arthroplasty (PIH) were treated. Their average age was 79.8 years. Eleven patients were rated ASA III preoperatively. The prostheses were on average 23.8 weeks old when the first signs of infection occurred. In 10 cases the infection was caused by Staphylococcus (MRSA 3x). The main comorbidities were hypertension, diabetes, coronary heart disease and thyroid malfunction.


RESULTS
After a mean 8.83 months, six patients were deceased (average age 85.50 years). In five of the remaining six patients the fistula worked without any problem. In one case the fistula was occluded. None of the patients showed any sign of acute infection. All were able to walk with full weight-bearing on the affected hip.


CONCLUSIONS
Restricting the indication to old, polymorbid patients, preservation of the arthroplasty in combination with local surgical debridement, permanent fistula and long-term systemic administration of antibiotics seems to be an alternative to explantation of the prosthesis with consecutive revision arthroplasty or resection arthroplasty.
Abteilung für Septische und Rekonstruktive Chirurgie, Klinik für Unfall- und Wiederherstellungschirurgie,BG-Kliniken Bergmannstrost, Merseburger Strasse 165, 06112, Halle Saale, Deutschland. andreas.tiemann@bergmannstrost.com
A H
AH
Tiemann
L
L
Homagk
M
M
Diefenbeck
T
T
Mückley
G O
GO
Hofmann
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D003646:Debridement; D005260:Female; D006304:Health Status; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010166:Palliative Care; D016459:Prosthesis-Related Infections / Q000188:drug therapy; D012086:Reoperation; D013997:Time Factors
D000900:Anti-Bacterial Agents