Two-stage Total Hip Arthroplasty: How Often Does It Control Methicillin-resistant Infection?

Abstract

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Early prosthetic hip joint infection treated with debridement, prosthesis retention and biofilm‐active antibiotics: functional outcomes, quality of life and complications

“…The 12-month mean SF-12 PCS score of 33.7 for cases is similar to that reported in one previous study examining outcomes after treatment with two-stage exchange. 18 There was no improvement between pre-arthroplasty and post-arthroplasty SF-12 MCS score for either cases or controls and no differences between the groups; however, preoperative MCS scores were already in the high range, minimising potential for further improvement. Smaller gains in the SF-12 MCS score have been seen previously post-arthroplasty 12 suggesting that mental health is not significantly impacted by hip arthroplasty regardless of the presence of PJI.…”

“…Baseline demographic information of cases and controls is shown in Table 1. For cases, the median duration from joint insertion until first debridement (joint age) was 14 days (interquartile range (IQR) [12][13][14][15][16][17][18][19][20]. The median duration of symptoms until debridement was 4 days (IQR 3-9).…”

Partial Two-stage Exchange for Infected Total Hip Arthroplasty: A Preliminary Report

“…In these situations, we wondered whether patients could be treated successfully for their infections without removing the well-fixed femoral components by using aggressive débride-ment and an antibiotic-laden acrylic cement femoral head in the acetabulum as well as a minimum of 6 weeks of IV antibiotics before reimplantation of a new acetabular component. A search of Medline, PubMed, and Medscape revealed one article on the subject of two-stage partial exchange for chronic PJI [39].…”

One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

“…One very experienced group reports equivalent success with cemented and cementless revision for infected THA with approximately 10% developing recurrent infection when treating antibiotic sensitive organisms (MSSA and MSSE), whereas 21% of the cases with antibiotic resistant organisms (MRSA and MRSE) developed recurrent infection. Other studies have noted recurrent infection occurring in 21%-48% of hips infected with MRSA or MRSE [28,34] with standard spacer and intravenous antibiotic techniques. In contrast, the results reported in this study may suggest that the antibiotic delivery system offered an advantage in treating THA infected with resistant organisms, possibly as a result of the effect of prolonged exposure to local antibiotics in high concentration on biofilm-forming bacteria protected by glycocalyx.…”

“…Finally, nearly all the hips in this study were infected with staphylococcus, so little can be determined regarding the effectiveness of this method of treatment for Gram-negative, mixed bacterial, or fungal infections. However, staphylococcal infections, especially those involving methicillin-resistant bacteria, are difficult to treat [28,34,59] and certainly represent a challenging test for our method.…”