Encouraging outcomes of staged, uncemented arthroplasty with short-term antibiotic therapy for treatment of recalcitrant septic arthritis of the native hip.
BACKGROUND
Septic arthritis in native hip joints is a rare but serious condition in adult patients. Prompt aggressive surgical and medical treatment is a challenge, and the outcomes after delayed management can be devastating. This article reports the findings of treatment of recalcitrant cases using a standardized protocol.


METHODS
Fourteen consecutive patients (15 hips) were treated with two-stage total hip arthroplasty (THA) for septic arthritis of the hip joint over a 6-year period. All patients underwent resection arthroplasty and implantation of an antibiotic-loaded articulating spacer in the first stage, short-term systemic antibiotic therapy during the interim period, and subsequent THA without bone cement in the second stage.


RESULTS
One patient required additional debridement and spacer reinsertion before THA. The mean interim period was 12.9 weeks (range, 6-31 weeks). After an average follow-up period of 42.5 months (range, 25-72 months) after THA, there was no evidence of recurrent infection or loosening of the prostheses in any patient. The average Merle D'Aubigne and Postel hip score improved from 9.3 (range, 5-15) to 13.5 (range, 12-16) between stages and to 16.7 (range, 15-18) at the latest follow-up.


CONCLUSIONS
Two-stage uncemented THA is a reliable treatment option for adult patients with recalcitrant septic hips. If an antibiotic-loaded interim spacer is used, routine, prolonged systemic antibiotic therapy may not be necessary.
Huang
Tsan-Wen
TW
Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Huang
Kuo-Chin
KC
Lee
Po-Cheng
PC
Tai
Ching-Lung
CL
Hsieh
Pang-Hsin
PH
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000188:drug therapy* / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000517:prevention & control; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents