Skip to main content
SpringerLink
Log in

Treatment of Early and Late Infection Following THA

  • Chapter
  • First Online:
Book cover European Instructional Lectures

Part of the book series: European Instructional Lectures ((EICL,volume 13))

  • 1184 Accesses

Abstract

A list of previous literature must be evaluated to decide the most adequate treatment for an infected hip arthroplasty. Suppressive antibiotics without surgery may be used in Tsukayama type IV infections, Cierny C patients, and repeated surgery rejection. Surgical debridement maintaining the implant is used for early infections, but lately there are important doubts about the period for considering “early” an infection, as well as which components of the arthroplasty should be easily changed. Girdlestone results are not so good as many Orthopaedic surgeons think, so indications should be absolutely restricted to non-ambulatory patients, intravenous drug abuse, and in some cases of dementia or advanced immunocompromise.

One-stage exchange presents important theoretical and practical problems, so the list of contra-indications is very extensive; its results are not excellent. Two-stage exchange, on the contrary, presents clear theoretical and practical advantages, but it is also inconvenient; results are the best among all treatment modalities, especially with modern protocols. There is a list of controversies about two-stage: period and route of antibiotic administration, use of spacers, time between surgeries, use of allograft, and type of fixation for re-implantation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Alexeeff M, Mahomed N, Morsi E, Garbuz D, Gross A (1996) Structural allograft in two-stage revisions for failed septic hip arthroplasty. J Bone Joint Surg Br 78-B:213–216

    Google Scholar 

  2. Barberan J, Aguilar L, Carroquino G et al (2006) Conservative treatment of staphylococcal prosthetic joint infections in elderly patients. Am J Med 119:993 e7–993 e10

    Article  Google Scholar 

  3. Barrack RL, Aggarwal A, Burnett RS (2006) Resection arthroplasty: when enough is enough. Orthopedics 29:820–821

    PubMed  Google Scholar 

  4. Berbari EF, Osmon DR, Duffy MC, Harmssen RN, Mandrekar JN, Hanssen AD, Steckelberg JM (2006) Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes. Clin Infect Dis 42:216–223

    Article  PubMed  Google Scholar 

  5. Berry DJ, Chandler HP, Reilly DT (1991) The use of bone allografts in two-stage reconstruction after failure of hip replacements due to infection. J Bone Joint Surg Am 73-A:1460–1468

    Google Scholar 

  6. Bourne RB, Hunter GA, Rorabeck CH, Macnab JJ (1984) A six-year follow-up of infected total hip replacements managed by Girdlestone’s arthroplasty. J Bone Joint Surg Br 66:340–343

    PubMed  CAS  Google Scholar 

  7. Buttaro MA. Comba F, Piccaluga F (2009) Proximal femoral reconstructions with bone impaction grafting and metal mesh. Clin Orthop Relat Res 467:2325–2334

    Article  PubMed  Google Scholar 

  8. Buttaro MA, Pusso R, Piccaluga F (2005) Vancomycin-supplemented impacted bone allografts in infected hip arthroplasty. Two-stage revision results. J Bone Joint Surg Br 87-B:314–319

    Article  Google Scholar 

  9. Buttaro M, Valentini R, Piccaluga F (2004) Persistent infection associated with residual cement after resection arthroplasty of the hip. Acta Orthop Scand 75:427–429

    PubMed  Google Scholar 

  10. Callaghan JJ, Katz RP, Johnston RC (1999) One-stage revision surgery of the infected hip. A minimum 10-year followup study. Clin Orthop Relat Res 369:139–143

    Article  PubMed  Google Scholar 

  11. Cherney DL, Amstutz HC (1983) Total hip replacement in the previously septic hip. J Bone Joint Surg Am 65:1256–1265

    PubMed  CAS  Google Scholar 

  12. Cierny GI, DiPasquale D (2002) Periprosthetic total joint infections: staging, treatment, and outcomes. Clin Orthop 403:23–28

    Article  PubMed  Google Scholar 

  13. Colyer RA, Capello WN (1994) Surgical treatment of the infected hip implant. Two stage reimplantation with a one-month interval. Clin Orthop Relat Res 298:75–79

    PubMed  Google Scholar 

  14. Cordero J (1999) Infection of orthopaedic implants. Theory and practice. Eur Instr Course Lect 4:65–73

    Google Scholar 

  15. Cordero-Ampuero J (2012) Girdlestone procedure: when and why. Hip Int 22(Suppl 8):S36–S39

    Article  PubMed  Google Scholar 

  16. Cordero J, García-Cimbrelo E (2000) Mechanisms of bacterial resistance in implant infection. Hip Int 10:139–144

    Google Scholar 

  17. Cordero-Ampuero J, Esteban J, García-Cimbrelo E (2009) Oral antibiotics are effective for highly resistant hip arthroplasty infections. Clin Orthop 467:2335–2342

    Article  PubMed  Google Scholar 

  18. Cordero-Ampuero J, Esteban J, García-Cimbrelo E, Munuera L, Escobar R (2007) Low relapse with oral antibiotics and two-stage exchange for late arthroplasty infections in 40 patients after 2–9 years. Acta Orthop 78:511–519

    Article  PubMed  Google Scholar 

  19. Drancourt M, Stein A, Argenson JN et al (1993) Oral rifampin plus ofloxacin for treatment of staphylococcus-infected orthopedic implants. Antimicrob Agents Chemother 37:1214–1218

    Article  PubMed  CAS  Google Scholar 

  20. Duncan CP, Beauchamp C (1993) A temporary ­antibiotic-loaded joint replacement system for management of complex infections involving the hip. Orthop Clin North Am 24:751–759

    PubMed  CAS  Google Scholar 

  21. El Helou OC, Berbari EF, Marculescu CE, El Atrouni WI, Razonable RR, Steckelberg JM, Hanssen AD, Osmon DR (2008) Outcome of enterococcal prosthetic joint infection: is combination systemic therapy superior to monotherapy? Clin Infect Dis 47:903–909

    Article  PubMed  Google Scholar 

  22. English H, Timperley AJ, Dunlop D, Gie G (2002) Impaction grafting of the femur in two-stage revision for infected total hip replacement. J Bone Joint Surg Br 84-B:700–705

    Article  Google Scholar 

  23. Esenwein SA, Robert K, Kollig E, Ambacher T, Kutscha-Lissberg F, Muhr G (2001) Long-term results after resection arthroplasty according to Girdlestone for treatment of persisting infections of the hip joint. Chirurg 72:1336–1343

    Article  PubMed  CAS  Google Scholar 

  24. Esteban J, Cordero-Ampuero J (2011) Treatment of prosthetic osteoarticular infections. Expert Opin Pharmacother 12:899–912

    Article  PubMed  CAS  Google Scholar 

  25. Esteban J, Molina-Manso D, Spiliopoulou I, Cordero-Ampuero J, Fernández-Roblas R, Foka A, Gómez-Barrena E (2010) Biofilm development by clinical isolates of Staphylococcus spp. from retrieved orthopaedic prosthesis. Acta Orthop 81:674–679

    Article  PubMed  Google Scholar 

  26. Garvin KL, Evans BG, Salvati EA, Brause BD (1994) Palacos gentamicin for the treatment of deep periprosthetic hip infections. Clin Orthop Relat Res 298:97–105

    PubMed  Google Scholar 

  27. Garvin KL, Fitzgerald RH, Salvati EA (1993) Reconstruction of the infected total hip and knee arthroplasty with gentamicin-impregnated Palacos bone cement. Instr Course Lect 42:293–302

    PubMed  CAS  Google Scholar 

  28. Gómez-Barrena E, Esteban J, Medel F, Molina-Manso D, Ortiz-Pérez A, Cordero-Ampuero J, Puértolas JA (2012) Bacterial adherence to separated modular components in joint prosthesis: a clinical study. J Orthop Res 30:1634–1639

    Article  PubMed  Google Scholar 

  29. Goulet JA, Pellici PM, Brause BD, Salvati EM (1988) Prolonged suppression of infection in total hip arthroplasty. J Arthroplasty 3:109–116

    Article  PubMed  CAS  Google Scholar 

  30. Haddad FS, Masri BA, Garbuz DS, Duncan CP (1999) The treatment of the infected hip replacement. The complex case. Clin Orthop 369:144–156

    Article  PubMed  Google Scholar 

  31. Haddad FS, Muirhead-Allwood SK, Manktelow AR, Bacarese-Hamilton I (2000) Two-stage uncemented revision hip arthroplasty for infection. J Bone Joint Surg Br 82-B:689–694

    Article  Google Scholar 

  32. Hanssen AD, Rand JA (1999) Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect 48:111–122

    PubMed  CAS  Google Scholar 

  33. Hirakawa K, Stulberg BN, Wilde AH et al (1998) Results of 2-stage reimplantation for infected total knee arthroplasty. J Arthroplasty 13:22–28

    Article  PubMed  CAS  Google Scholar 

  34. Hunter GA (1979) The results of reinsertion of a total hip prosthesis after sepsis. J Bone Joint Surg Br 61-B:422–423

    PubMed  CAS  Google Scholar 

  35. Kantor GS, Osterkamp JA, Dorr LD, Fischer D, Perry J, Conaty JP (1986) Resection arthroplasty following infected total hip replacement arthroplasty. J Arthroplasty 1:83–89

    Article  PubMed  CAS  Google Scholar 

  36. Klima S, Zeh A, Josten C (2008) Reimplantation of a hip prosthesis in patients with an infected resection arthroplasty. Z Orthop Unfall 146:616–623

    Article  PubMed  CAS  Google Scholar 

  37. Kordelle J, Frommelt L, Kluber D et al (2000) Results of one-stage endoprosthesis revision in periprosthetic infection cause by methicillin-resistant Staphylococcus aureus. Z Orthop Ihre Grenzgeb 138:240–244

    Article  PubMed  CAS  Google Scholar 

  38. Lai KA, Shen WJ, Yang CY, Lin RM, Lin CJ, Jou IM (1996) Two-stage cementless revision THR after infection 5 recurrences in 40 cases followed 2.5-7 years. Acta Orthop Scand 67:325–328

    Article  PubMed  CAS  Google Scholar 

  39. Lieberman JR, Callaway GH, Salvati EA et al (1994) Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol. Clin Orthop 301:205–212

    PubMed  Google Scholar 

  40. Manjón-Cabeza Subirat JM, Moreno Palacios JA, Mozo Muriel AP, Cátedra Vallés E, Sancho Loras R, Ubeda Tikkanen A (2008) Functional outcomes after resection of hip arthroplasty (Girdlestone technique). Rev Esp Geriatr Gerontol 43:13–18

    Article  PubMed  Google Scholar 

  41. Masri BA, Duncan CP, Beauchamp CP (1998) Long-term elution of antibiotics from bone-cement: an in vivo study using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) system. J Arthroplasty 13:331–338

    Article  PubMed  CAS  Google Scholar 

  42. McDonald DJ, Fitzgerald RH Jr, Ilstrup DM (1989) Two-stage reconstruction of a total hip arthroplasty because of infection. J Bone Joint Surg Am 71-A:828–834

    Google Scholar 

  43. McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M (2002) Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res 403:8–15

    Article  PubMed  Google Scholar 

  44. Nestor BJ, Hanssen AD, Ferrer-Gonzalez R, Fitzgerald RH Jr (1994) The use of porous prostheses in delayed reconstruction of total hip replacements that have failed because of infection. J Bone Joint Surg Am 76-A:349–359

    Google Scholar 

  45. Rao N, Crossett LS, Sinha RK, Le Frock JL (2003) Long-term suppression of infection in total joint arthroplasty. Clin Orthop Relat Res 414:55–60

    Article  PubMed  Google Scholar 

  46. Raut VV, Siney PD, Wroblewsky BM (1994) One-stage revision of infected total hip replacements with discharging sinuses. J Bone Joint Surg Br 76:721–724

    PubMed  CAS  Google Scholar 

  47. Ries MD, Jergesen H (1999) An inexpensive molding method for antibiotic-impregnated cement spacers in infected total hip arthroplasty. J Arthroplasty 14:764–765

    Article  PubMed  CAS  Google Scholar 

  48. Rittmeister M, Manthei L, Müller M, Hailer NP (2004) Reimplantation of the artificial hip joint in Girdlestone hips is superior to Girdlestone arthroplasty by itself. Z Orthop Ihre Grenzgeb 142:559–563

    Article  PubMed  CAS  Google Scholar 

  49. Rittmeister M, Müller M, Starker M, Hailer NP (2003) Functional results following Girdlestone arthroplasty. Z Orthop Ihre Grenzgeb 141:665–671

    Article  PubMed  CAS  Google Scholar 

  50. Salvati EA, Della-Valle AG, Masri BA et al (2003) The infected total hip arthroplasty. Instr Course Lect 52:223–246

    PubMed  Google Scholar 

  51. Segawa H, Tsukayama DT, Kyle RF et al (1999) Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am 81:1434–1445

    PubMed  CAS  Google Scholar 

  52. Sendi P, Rohrbach M, Graber P et al (2006) Staphylococcus aureus small colony variants in prosthetic joint infection. Clin Infect Dis 43:961–967

    Article  PubMed  Google Scholar 

  53. Sharma H, De Leeuw J, Rowley DI (2005) Girdlestone resection arthroplasty following failed surgical procedures. Int Orthop 29:92–95

    Article  PubMed  CAS  Google Scholar 

  54. Sharma H, Kakar R (2006) Outcome of Girdlestone’s resection arthroplasty following complications of proximal femoral fractures. Acta Orthop Belg 72:555–559

    PubMed  Google Scholar 

  55. Soriano A, Gomez J, Gomez L et al (2007) Efficacy and tolerability of prolonged linezolid therapy in the treatment of orthopedic implant infections. Eur J Clin Microbiol Infect Dis 26:353–356

    Article  PubMed  CAS  Google Scholar 

  56. Stockley I, Mockford BJ, Hoad-Reddick A et al (2008) The use of two-stage exchange arthroplasty with depot antibiotics in the absence of long-term antibiotic therapy in infected total hip replacement. J Bone Joint Surg Br 90:145–148

    PubMed  CAS  Google Scholar 

  57. Stoklas J, Rozkydal Z (2004) Resection of head and neck of the femoral bone according to Girdlestone. Acta Chir Orthop Traumatol Cech 71:147–151

    PubMed  CAS  Google Scholar 

  58. Trebse R, Pisot V, Trampuz A (2005) Treatment of infected retained implants. J Bone Joint Surg Br 87-B:249–256

    Article  Google Scholar 

  59. Tsukayama DT, Estrada R, Gustilo RB (1996) Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 78-A:512–523

    Google Scholar 

  60. Volin SJ, Hinrichs SH, Garvin KL (2004) Two-stage reimplantation of total joint infections: a comparison of resistant and non-resistant organisms. Clin Orthop Relat Res 427:94–100

    Article  PubMed  Google Scholar 

  61. Wang JW, Chen CE (1997) Reimplantation of infected hip arthroplasties using bone allografts. Clin Orthop Relat Res 335:202–210

    Article  PubMed  Google Scholar 

  62. Whittaker JP, Warren RE, Jones RS, Gregson PA (2009) Is prolonged systemic antibiotic treatment essential in two-stage revision hip replacement for chronic Gram-positive infection? J Bone Joint Surg Br 91-B:44–51

    Article  Google Scholar 

  63. Younger AS, Duncan CP, Masri BA (1998) Treatment of infection associated with segmental bone loss in the proximal part of the femur in two stages with use of an antibiotic-loaded interval prosthesis. J Bone Joint Surg Am 80-A:60–69

    Google Scholar 

  64. Younger AS, Duncan CP, Masri BA, McGraw RW (1997) The outcome of two-stage arthroplasty using a custom-made interval spacer to treat the infected hip. J Arthroplasty 12:615–623

    Article  PubMed  CAS  Google Scholar 

  65. Zimmerli W, Widmer AF, Blatter M et al (1998) Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. JAMA 279:1537–1541

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain

    José Cordero-Ampuero

Authors
  1. José Cordero-Ampuero
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to José Cordero-Ampuero .

Editor information

Editors and Affiliations

  1. Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, United Kingdom

    George Bentley

Rights and permissions

Reprints and permissions

Copyright information

© 2013 EFORT

About this chapter

Cite this chapter

Cordero-Ampuero, J. (2013). Treatment of Early and Late Infection Following THA. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 13. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36149-4_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-36149-4_17

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-36148-7

  • Online ISBN: 978-3-642-36149-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation