Acute Delayed or Late Infection of Revision Total Hip Arthroplasty Treated with Debridement/Antibiotic-loaded Cement Beads and Retention of the Prosthesis.
OBJECTIVE
The treatment of infected revision total hip arthroplasty (THA) is very challenging due to retained revision prosthesis, poor bone stock and soft tissue condition derived from previous revision surgeries, and comorbidities. The purpose of this study was to investigate the effectiveness and short-term outcomes of aggressive debridement and use of antibiotic-loaded cement beads with retention of the prosthesis for acute delayed or late infection of revision THAs.


METHODS
Ten consecutive patients with symptoms or signs of less than one-week evolution and well-fixed prostheses, were treated with this procedure and a postoperative course of organism-specific antibiotics for a minimum of 6 weeks. All hips presented with acute delayed or late infection of revision THAs. Patients with a mean age of 68.1 years (range, 59-78 years) underwent an average of 1.9 previous revision THAs (1-4) before the index surgery. The minimal follow-up was 2 years with a mean of 46.2 months (range, 24-64 months).


RESULTS
There were 8 cures (80.0%) and 2 failures with no mortality during the study period. The 2 failures involved the same and resistant bacteria implicated in the primary infection (methicillin-resistantStaphylococcus aureusandPrevotella oralis, respectively). The mean Harris hip score was 65.2 (range, 26-83) and the mean visual analogue scale was 2.6 (range, 1-4) at final follow-up.


CONCLUSIONS
With a favorable success rate and no mortality, our procedure may be considered a safe and effective alternative for the treatment of acute delayed or late infection of revision THAs with well-fixed prostheses.
Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong, Korea.
Jun-Dong
JD
Chang
Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong, Korea.
In-Sung
IS
Kim
Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University School of Medicine, Chuncheon, Korea.
Sang-Soo
SS
Lee
Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Korea.
Je-Hyun
JH
Yoo
Acute infection; Antibiotic-loaded cement bead; Debridement; Retention of the prosthesis; Revision; Total hip arthroplasty