Acute Delayed or Late Infection of Revision Total Hip Arthroplasty Treated with Debridement/Antibiotic-loaded Cement Beads and Retention of the Prosthesis

Abstract

PurposeThe 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.Materials and MethodsTen 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).ResultsThere 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-resistant Staphylococcus aureus and Prevotella 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.ConclusionWith 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.

Midterm outcome of fourth-generation ceramic-on-ceramic bearing surfaces in revision total hip arthroplasty

“…Hence, we tried to treat these two cases with meticulous debridement and antibiotic-loaded cement beads with retention of well-fixed prostheses, based on our previous experience. 34 The femoral head and acetabular liner were intraoperatively changed with the fourth-generation CoC bearing couple. Microorganism-specific intravenous antibiotics were administered for 6 weeks.…”

Promising applications of D-amino acids in periprosthetic joint infection

“…However, the majority (65%) of PJIs occur within 1 year of surgery. 34,44 When PJIs develop, quality of life and function are severely decreased, 42,[45][46][47] health care costs increase up to 5-fold 46,48 (US$30 000-120 000 per patient, [49][50][51][52] ) and surgical amputation of the affected limb may be performed to resolve the complication. 53 Furthermore, PJIs are associated with mortality rates of 2%-4% within 90 days 54,55 and 20%-26% within 5 years 54,56 postinfection; the 5-year mortality rate is reported to be greater than that of four of the five most commonly diagnosed cancers in the United States.…”