Elsevier

The Journal of Arthroplasty

Volume 24, Issue 7, October 2009, Pages 1051-1060
The Journal of Arthroplasty

Treatment of Infected Total Hip Arthroplasty With a 2-Stage Reimplantation Protocol: Update on “Our Institution's” Experience From 1989 to 2003

https://doi.org/10.1016/j.arth.2008.07.004Get rights and content

Abstract

Infection is a devastating complication of total hip arthroplasty (THA). This study aimed to determine whether 2-stage reimplantation is still effective for treating contemporary pathogens, including multidrug-resistant organisms. Records of all cases of infected THAs from 1989 to 2003 were reviewed for data on organism, presence of drug resistance, use of an antibiotic-impregnated spacer, type of reimplant, and success of treatment. Of the 87 protocol patients with 2 years of follow-up, 94.3% (82) underwent reimplantation. The original infection was eradicated in 80 of the 84 hips (78/82 patients), a success rate of 95%. All 21 multidrug-resistant infections were eradicated. There were no major differences in eradication rates when the period was split into 3 sections. These results support previous studies from our institution which demonstrated the effectiveness of a 2-stage reimplantation protocol with a standard 1:8 minimal bactericidal titer for treating infections after THA, including those due to methicillin-resistant organisms.

Section snippets

Materials and Methods

All 132 cases of infected THAs treated at our institution between 1989 and 2003 were screened for inclusion. At the time of the study, 34 patients were deceased without 2 years of follow-up (either passed away <2 years postoperatively or passed away before they could be contacted for follow-up). Records for 2 of these 34 patients were unavailable. Of the remaining 32 patients, 19 (59.4%) were able to undergo reimplantation surgery and 28 (87.5%) were free of infection at an average of 7.2

Results

There were 82 patients (84 hips) who completed the entire protocol, including 48 men (58.5%) and 34 women (41.5%). The average age at index THA was 54.7 years (range, 17-81 years) and the average age at removal was 61.8 years (range, 32-86 years). The average follow-up duration was 64.8 months with a range from 24 months (the minimum for inclusion) to 203.5 months. The diagnosis that prompted the initial hip arthroplasty was most commonly osteoarthritis, which afflicted 59.5% of hips (50/84). A

Discussion

Our institution was one of the first to study reimplantation of infected THA in the United States 6, 8, 17, 18, 19, 20. In the initial study, Wilson et al. 17, 18 reported on 19 patients treated with complete removal of all foreign material in the hip followed by reconstruction in a second operative session. There were 2 recurrences of infection after an average of 8 years of follow-up (range, 6-9 years). A more extensive follow-up study [19] reviewed each case individually and made

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    No benefits or funds were received in support of the study.

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