Vacuum-assisted closure in the treatment of early hip joint infections

Abstract

The aim of the present study was to evaluate the efficacy of the vacuum-assisted closure (V.A.C.) system in the treatment of early hip joint infections. 28 patients (11 m / 17 f; mean age 71 y. [43-84]) with early hip joint infections have been treated by means of the V.A.C.-therapy. At least one surgical revision [1-7] has been unsuccessfully performed for infection treatment prior to V.A.C. - application. Pathogen organisms could have been isolated in 22/28 wounds. During revision, cup inlay and prosthesis head have been exchanged and 1-3 polyvinylalcohol sponges inserted into the wound cavity/ periprosthetically at an initial continuous pressure of 200 mm Hg. Postoperatively, a systemic antibiosis was given according to antibiogram. 48-72 h after surgery an alteration from haemorrhagic to serous fluid was observed in the V.A.C.-canister. Afterwards, the pressure was decreased to 150 mm Hg and remained at this level till sponge removal. After a mean period of 9 [3-16] days the inflammation parameters have been retrogressive and the sponges were removed. An infection eradication could be achieved in 26/28 cases. In the two remaining cases the infected prosthesis had to be explanted and a gentamicin-vancomycin-loaded spacer has been implanted, respectively. At a total mean follow-up of 36 [12-87] months no reinfection or infection persistence was observed. The V.A.C.-system can be a valuable contribution in the treatment of early joint infections when properly used. Indications should be early infections with well-maintained soft-tissues for retention of the negative atmospheric pressure.

Can periprosthetic hip joint infections be successfully managed by debridement and prosthesis retention?

“…A total of 11 studies reporting on 292 cases could be identified ( Figure 1) [2][3][6][7][8][9][10][11][12][13][14] . Two studies were published before and nine after 2000.…”

“…Six studies performed debridement, lavage and change of modular prosthesis components (polyethylene (PE) liner, femoral stem head) [2,3,6,7,9,14] , whereas in one of these studies the PE liner was not changed in all patients [9] . One study combined this procedure along with the use of the vacuum-assisted closure therapy [11] . Two studies reported on partial prosthesis retention [8,13] .…”

“…[12] 89.6% (26/29) [8,13] 92.8% (26/28) [11] 70.4% (126/179) [2,3,6,7,9,14] ing factors identified no difference between methicillinsensitive and methicillin-resistant staphylococcus or head/liner exchange and no exchange [9] . These findings are contradictory to the general acceptance that prosthesis retention is feasible at the site of early infection with a short duration of symptoms.…”

“…12 All late 2 Ⅳ Choi et al [9] 2012 28 All early 3 Ⅲ Crockarell et al [10] 1998 [11] 2009 28 All early 2 Ⅳ Klouche et al [12] 2011 12 All early 3 Ⅳ Lee et al [13] 2013 19 10 late 3 Ⅳ 9 acute hematogenous Tsukayama et al [2] 1996 41 35 early 3 Ⅳ 6 acute hematogenous Waagsbø et al [3] 2009 40 30 early 4 Ⅳ 10 late Westberg et al [14] 2013…”

Topical Negative Pressure Therapy and Interactive Dressings in Prevention of Wound Infections in High-Risk Orthopaedic Patients

“…It is also known that the most effective method of prevention and treatment of infected wound complications is topical application of negative pressure -TNP [23][24][25][26][27]. Thus in the study by Condé-Green A [28].…”