[Retention of the prosthesis in early periprosthetic infection after total hip arthroplasty]

Abstract

Background: The rate of periprosthetic infection after total hip arthroplasty (THA) without patient-specific risk factors is about 1 %. The therapeutic challenges are control of infection, restoration of hip function and prevention of reinfection. In early infection, "irrigation and debridement" (I&D) with exchange of mobile components and retention of the prosthesis remains an attractive alternative to one- or two-stage revision. However, variable results have been reported in the literature. Recent studies have shown new algorithms of treatment for early infection and acute haematogenous infection after THA.

Patients and methods: Recent therapeutic algorithms for early infections after THA and an overview of the literature are presented. We conducted a retrospective analysis of 73 patients with early postoperative infection or acute haematogenous infection (symptoms shorter than 4 weeks) after THA who were treated with I&D, exchange of mobile components and retention of the prosthesis at our hospital between 2002 and 2011.

Results: RESULTS from the recent literature have shown that the treatment concept of prosthetic retention can only be successful within a maximum time of symptoms of 3 weeks in cases of haematogenous infection and a maximum time span of 4 weeks after index operation in cases of early infection. In our retrospective study with 73 patients, the treatment was successful (free of infection) in 46 patients (63 %). A persistence of infection occurred in 27 patients (37 %). "Difficult to treat" bacteria were present in 28.8 % of the patients.

Conclusion: The concept of irrigation and debridement with retention of the prosthesis is a valuable alternative to one- or two-stage revision THA, if a maximum time of 4 weeks after index operation in early infections and a maximum time of symptoms of 3 weeks in haematogenous infections are not exceeded. However, reinfection rates after I&D are higher than after two-stage procedures. Prerequisites for success of the I&D algorithm are a stable prosthesis, operable soft tissues, and germs susceptible to antibiotic treatment.