title: Similar success rates for single and multiple debridement surgery for acute hip arthroplasty infection.
abstract: BACKGROUND
  Treatment of an acute total hip arthroplasty (THA) infection aims at control of the infection with retention of the implant by surgical debridement and antibiotic treatment. There is no clear evidence whether a single surgical debridement is sufficient or whether multiple procedures are necessary for optimal treatment.
  
  
  METHODS
  From a prospective database of patients with acute THA infection, we retrospectively reviewed 68 patients treated in 2 large teaching hospitals. Hospital S used a protocol in which each patient received a single surgical debridement and only additional surgery if infectious symptoms persisted (group S; n = 33). In hospital M, patients always received multiple surgical debridements (group M; n = 35). Both groups received systemic antibiotic treatment. Removal of the implant or persistent infection at follow-up was considered failure of treatment. Mean follow-up of the patients was 5 (2-11) years.
  
  
  RESULTS
  Mean time between implantation and debridement was 19 days. 4 patients in group S were considered failure, as opposed to 10 patients in group M (p = 0.09). 9 patients in group S had additional surgery, which resulted in 3 of the 4 failures. At final follow-up, 30 patients in group S and 33 patients in group M had a good clinical result (p = 0.6).
  
  
  CONCLUSIONS
  In patients with acute THA infection, a single debridement with only additional surgery on indication appears to be at least as successful for retention of the primary implant and control of infection as a strategy with multiple surgical debridements.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology , Joint Research, Onze Lieve Vrouwe Gasthuis , Amsterdam.
authors.forename: Dirk Jan F
authors.initials: DJ
authors.lastname: Moojen
authors.forename: Jasper H
authors.initials: JH
authors.lastname: Zwiers
authors.forename: Vanessa A B
authors.initials: VA
authors.lastname: Scholtes
authors.forename: Cees C P M
authors.initials: CC
authors.lastname: Verheyen
authors.forename: Rudolf W
authors.initials: RW
authors.lastname: Poolman
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016208:Databases, Factual; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents