Two-stage Reimplantation of Infected Hip Arthroplasties

Wun-Schen Chen, Te-Hu Fu, Jun-Wen Wang
2009 Chang Gung Med J   unpublished
Although two-stage reimplantation for infected hip arthroplasty has a high success rate, the protocols of the antibiotic therapy after resection arthroplas-ty have varied in different reports. The purpose of this study was to evaluate the clinical outcomes of two-stage reimplantation for infected hip arthroplas-ty using our protocol of combined parenteral and oral antibiotic therapy and the criterion for reimplantation. Methods: Forty-seven patients (48 hips) with infected hip arthroplasty were
more » ... p arthroplasty were treated with two-stage reimplantation using interim antibiotic-impregnated cement beads with an average 2.6 weeks of parenteral antibiotic and 6 weeks of oral antibiotic therapy. The timing for reimplantation was determined using the values of erythrocyte-sedimentation rate (ESR) and C-reactive protein (CRP) with no clinical signs of infection. The average follow-up period was 5.6 years. Results: Forty-six (96%) hips were free of recurrent infection according to clinical examination and laboratory tests at the latest follow up. All 48 hips had negative tissue culture results obtained at the second-stage reimplantation except one which resulted in a recurrent infection. The average interim period of time from the first-stage procedure to reimplantation was 5.4 months (range, 2-24 months). Two hips had recurrent infections after reimplantation. The mean Harris hip score improved from 26 points preoperatively to 83 points at the latest follow up. Thirty-five patients (74%) achieved excellent or good results. Conclusions: Two-stage reimplantation of an infected hip arthroplasty can achieve a high success rate using the protocol of aggressive surgical debridement, local antibiotic-loaded cement beads, combined parenteral and oral antibiotic therapy and reimplantation after normalization of ESR and CRP levels.