title: Aggressive early débridement for treatment of acutely infected cemented total hip arthroplasty.
abstract: BACKGROUND
  Up to 2% of THAs are complicated by infection, leading to dissatisfied patients with poor function and major social and economic consequences. The challenges are control of infection, restoration of full function, and prevention of recurrence. Irrigation and débridement with or without exchange of modular components remains an attractive alternative to two-stage reimplantation in acutely infected THAs but with variable results from previous studies.
  
  
  OBJECTIVE
  We therefore determined the rate at which aggressive early débridement with exchange of modular components controlled acutely infected cemented THAs.
  
  
  METHODS
  We retrospectively studied all 26 patients presenting with acutely infected cemented THAs (16 primaries, 10 revisions) occurring within 6 weeks of the index operation or of hematogenous spread from a confirmed source of infection elsewhere between 1999 and 2006. Microbiology confirmed bacterial colonization in all patients, with 18 early postoperative infections and eight acute hematogenous infections. Patients underwent aggressive débridement with open complete synovectomy, exchange of all mobile parts, débridement of all aspects of the joint, irrigation with antiseptic solutions, and pulsatile lavage. Minimum followup was 5 years (mean, 6.6 years; range, 5-11 years).
  
  
  RESULTS
  Eight patients had multiple washouts with control of infection in four at latest followup. Five patients underwent two-stage revisions and one patient was placed on long-term antibiotic suppression. Twenty patients returned to their expected functional level with no radiographic evidence of prosthetic failure. At minimum 5-year followup, we had a 77% infection control rate.
  
  
  CONCLUSIONS
  Our data confirm current literature and suggest there may be a role for aggressive early débridement in controlling acute postoperative and hematogenous infections after cemented THA.
  
  
  METHODS
  Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
authors: Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, NW1 2BU London, United Kingdom. msukeik@hotmail.com
authors: Mohamed
authors: M
authors: Sukeik
authors: Shelain
authors: S
authors: Patel
authors: Fares Sami
authors: FS
authors: Haddad
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001843:Bone Cements; D003646:Debridement; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D007507:Therapeutic Irrigation
chemical_list: D001843:Bone Cements