Treatment of infected total hip arthroplasty with a 2-stage reimplantation protocol: update on "our institution's" experience from 1989 to 2003.
Infection is a devastating complication of total hip arthroplasty (THA). This study aimed to determine whether 2-stage reimplantation is still effective for treating contemporary pathogens, including multidrug-resistant organisms. Records of all cases of infected THAs from 1989 to 2003 were reviewed for data on organism, presence of drug resistance, use of an antibiotic-impregnated spacer, type of reimplant, and success of treatment. Of the 87 protocol patients with 2 years of follow-up, 94.3% (82) underwent reimplantation. The original infection was eradicated in 80 of the 84 hips (78/82 patients), a success rate of 95%. All 21 multidrug-resistant infections were eradicated. There were no major differences in eradication rates when the period was split into 3 sections. These results support previous studies from our institution which demonstrated the effectiveness of a 2-stage reimplantation protocol with a standard 1:8 minimal bactericidal titer for treating infections after THA, including those due to methicillin-resistant organisms.
Department of Orthopedics, Hospital for Special Surgery, New York, New York 10021, USA.
Charles
C
Toulson
Sarah
S
Walcott-Sapp
John
J
Hur
Eduardo
E
Salvati
Mathias
M
Bostrom
Barry
B
Brause
Geoffrey H
GH
Westrich
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods*; D003131:Combined Modality Therapy; D016503:Drug Delivery Systems; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000382:microbiology*; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery*; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy; D013290:Streptococcal Infections / Q000188:drug therapy; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents