title: Historical perspective on two-stage reimplantation for infection after total hip arthroplasty at Hospital for Special Surgery, New York City.
abstract: In this article, we report on our use of a 2-stage exchange in managing infected total hip arthroplasties (THAs) at the Hospital for Special Surgery in New York City. This protocol involves resection arthroplasty, 6 weeks of intravenous antibiotics to obtain a minimum "postpeak" serum bactericidal titer (SBT) of 1:8, and reimplantation. Over the past 20 years, we have conducted several studies showing the effectiveness of this treatment. Since our previous report was published in 1994, prevalence of multidrug-resistant (MDR) organisms has increased significantly. In 2008, we set out to determine if 2-stage exchange remains an effective treatment for newer pathogens, many of which are MDR. The overall eradication rate was 95% (80/84 hips). All 21 MDR pathogens implicated in the infected THAs were eradicated. We conclude that 2-stage exchange with a standard 1:8 minimum SBT remains an effective treatment even when resistant infections are involved.
authors.affiliation: Department of Orthopedics, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA. westrichg@hss.edu
authors.forename: Geoffrey H
authors.initials: GH
authors.lastname: Westrich
authors.forename: Lindsey
authors.initials: L
authors.lastname: Bornstein
authors.forename: Barry D
authors.initials: BD
authors.lastname: Brause
authors.forename: Eduardo
authors.initials: E
authors.lastname: Salvati
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents