Two-stage reimplantation of infected hip arthroplasties.
BACKGROUND
Although two-stage reimplantation for infected hip arthroplasty has a high success rate, the protocols of the antibiotic therapy after resection arthroplasty have varied in different reports. The purpose of this study was to evaluate the clinical outcomes of two-stage reimplantation for infected hip arthroplasty using our protocol of combined parenteral and oral antibiotic therapy and the criterion for reimplantation.


METHODS
Forty-seven patients (48 hips) with infected hip arthroplasty were treated with two-stage reimplantation using interim antibiotic-impregnated cement beads with an average 2.6 weeks of parenteral antibiotic and 6 weeks of oral antibiotic therapy. The timing for reimplantation was determined using the values of erythrocyte-sedimentation rate (ESR) and C-reactive protein (CRP) with no clinical signs of infection. The average follow-up period was 5.6 years.


RESULTS
Forty-six (96%) hips were free of recurrent infection according to clinical examination and laboratory tests at the latest follow up. All 48 hips had negative tissue culture results obtained at the second-stage reimplantation except one which resulted in a recurrent infection. The average interim period of time from the first-stage procedure to reimplantation was 5.4 months (range, 2-24 months). Two hips had recurrent infections after reimplantation. The mean Harris hip score improved from 26 points preoperatively to 83 points at the latest follow up. Thirty-five patients (74%) achieved excellent or good results.


CONCLUSIONS
Two-stage reimplantation of an infected hip arthroplasty can achieve a high success rate using the protocol of aggressive surgical debridement, local antibiotic-loaded cement beads, combined parenteral and oral antibiotic therapy and reimplantation after normalization of ESR and CRP levels.
Chen
Wun-Schen
WS
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Fu
Te-Hu
TH
Wang
Jun-Wen
JW
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001424:Bacterial Infections / Q000000981:diagnostic imaging / Q000601:surgery*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012086:Reoperation
D002097:C-Reactive Protein