Abstract
Introduction
We present a series of 30 consecutive patients with 31 infected total hip arthroplasties treated by a single surgeon over a 4-year period in whom a shortened post-operative course of antimicrobial chemotherapy was used.
Methods
The treatment protocol consisted of a two-stage exchange with removal of infected components, insertion of an interim antibiotic eluting cement spacer and re-implantation of an extensively coated uncemented prosthesis on the femoral side. Systemic antibiotic treatment following each stage consisted of an abridged course of 5 days post-operative intra-venous administration followed by complete cessation of anti-microbial therapy.
Results
At a mean follow-up of 35 months (minimum 24 months), there were no cases of recurrent prosthetic infection and no patient had required revision for aseptic loosening or mechanical instability on the femoral side. The combination of effective-staged surgical joint debridement, a shortened post-operative course of systemic antibiotic treatment and an adequate latent period before re-implantation has led to encourage early results in this series of revised chronic hip joint prosthetic infections.
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References
Marotte JH, Lord GA, Blanchard JP, Guillamon JL, Samuel P, Servant JP et al (1987) Infection rate in total hip arthroplasty as a function of air cleanliness and antibiotic prophylaxis. 10-year experience with 2,384 cementless Lord madreporic prostheses. J Arthroplasty 2(1):77–82
Salvati EA, Chekofsky KM, Brause BD, Wilson PD Jr (1982) Reimplantation in infection: a 12-year experience. Clin Orthop Relat Res (170):62–75
Schutzer SF, Harris WH (1988) Deep-wound infection after total hip replacement under contemporary aseptic conditions. J Bone Joint Surg Am 70(5):724–727
Karrholm J, Garellick G, Herberts P (2006) Annual report 2006: the Swedish National Arthroplasty Register
Masterson EL, Masri BA, Duncan CP (1998) Treatment of infection at the site of total hip replacement. Instr Course Lect 47:297–306
Buchholz HW, Elson RA, Engelbrecht E, Lodenkamper H, Rottger J, Siegel A (1981) Management of deep infection of total hip replacement. J Bone Joint Surg Br 63-B(3):342–353
Ammon P, Stockley I (2004) Allograft bone in two-stage revision of the hip for infection. Is it safe? J Bone Joint Surg Br 86(7):962–965
Stockley I, Mockford BJ, Hoad-Reddick A, Norman P (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(2):145–148
Raut VV, Siney PD, Wroblewski BM (1994) One-stage revision of infected total hip replacements with discharging sinuses. J Bone Joint Surg Br 76(5):721–724
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(3):314–319
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(5):689–694
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(3):331–338
Wahlig H, Dingeldein E, Buchholz HW, Buchholz M, Bachmann F (1984) Pharmacokinetic study of gentamicin-loaded cement in total hip replacements. Comparative effects of varying dosage. J Bone Joint Surg Br 66(2):175–179
Bertazzoni Minelli E, Benini A, Magnan B, Bartolozzi P (2004) Release of gentamicin and vancomycin from temporary human hip spacers in two-stage revision of infected arthroplasty. J Antimicrob Chemother 53(2):329–334
Fitzgerald RH Jr, Nolan DR, Ilstrup DM, Van Scoy RE, Washington JAII, Coventry MB (1977) Deep wound sepsis following total hip arthroplasty. J Bone Joint Surg Am 59(7):847–855
Fisman DN, Reilly DT, Karchmer AW, Goldie SJ (2001) Clinical effectiveness and cost-effectiveness of 2 management strategies for infected total hip arthroplasty in the elderly. Clin Infect Dis 32(3):419–430
Jackson WO, Schmalzried TP (2000) Limited role of direct exchange arthroplasty in the treatment of infected total hip replacements. Clin Orthop Relat Res (381):101–105
Garvin KL, Hanssen AD (1995) Infection after total hip arthroplasty. Past, present, and future. J Bone Joint Surg Am 77(10):1576–1588
Adams K, Couch L, Cierny G, Calhoun J, Mader JT (1992) In vitro and in vivo evaluation of antibiotic diffusion from antibiotic-impregnated polymethylmethacrylate beads. Clin Orthop Relat Res (278):244–252
Hoff SF, Fitzgerald RH Jr, Kelly PJ (1981) The depot administration of penicillin G and gentamicin in acrylic bone cement. J Bone Joint Surg Am 63(5):798–804
Bunetel L, Segui A, Langlais F, Cormier M (1994) Osseous concentrations of gentamicin after implantation of acrylic bone cement in sheep femora. Eur J Drug Metab Pharmacokinet 19(2):99–105
Oxborrow NJ, Stamer J, Andrews M, Stone MH (1997) New uses for gentamicin-impregnated polymethyl methacrylate spacers in two-stage revision hip arthroplasty. J Arthroplasty 12(6):709–710
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(6):615–623
Klekamp J, Dawson JM, Haas DW, DeBoer D, Christie M (1999) The use of vancomycin and tobramycin in acrylic bone cement: biomechanical effects and elution kinetics for use in joint arthroplasty. J Arthroplasty 14(3):339–346
Smilack JD, Flittie WH, Williams TW Jr (1976) Bone concentrations of antimicrobial agents after parenteral administration. Antimicrob Agents Chemother 9(1):169–171
Canner GC, Steinberg ME, Heppenstall RB, Balderston R (1984) The infected hip after total hip arthroplasty. J Bone Joint Surg Am 66(9):1393–1399
Carlsson AS, Josefsson G, Lindberg L (1978) Revision with gentamicin-impregnated cement for deep infections in total hip arthroplasties. J Bone Joint Surg Am 60(8):1059–1064
Hope PG, Kristinsson KG, Norman P, Elson RA (1989) Deep infection of cemented total hip arthroplasties caused by coagulase-negative staphylococci. J Bone Joint Surg Br 71(5):851–855
Miley GB, Scheller AD Jr, Turner RH (1982) Medical and surgical treatment of the septic hip with one-stage revision arthroplasty. Clin Orthop Relat Res (170):76–82
Murray WR (1984) Use of antibiotic-containing bone cement. Clin Orthop Relat Res (190):89–95
Sanzen L, Carlsson AS, Josefsson G, Lindberg LT (1988) Revision operations on infected total hip arthroplasties. Two- to nine-year follow-up study. Clin Orthop Relat Res (229):165–172
Wroblewski BM (1986) One-stage revision of infected cemented total hip arthroplasty. Clin Orthop Relat Res (211):103–107
Takahira N, Itoman M, Higashi K, Uchiyama K, Miyabe M, Naruse K (2003) Treatment outcome of two-stage revision total hip arthroplasty for infected hip arthroplasty using antibiotic-impregnated cement spacer. J Orthop Sci 8(1):26–31
Hoad-Reddick DA, Evans CR, Norman P, Stockley I (2005) Is there a role for extended antibiotic therapy in a two-stage revision of the infected knee arthroplasty? J Bone Joint Surg Br 87(2):171–174
Kadurugamuwa JL, Sin LV, Yu J, Francis KP, Purchio TF, Contag PR (2004) Noninvasive optical imaging method to evaluate postantibiotic effects on biofilm infection in vivo. Antimicrob Agents Chemother 48(6):2283–2287
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McKenna, P.B., O’Shea, K. & Masterson, E.L. Two-stage revision of infected hip arthroplasty using a shortened post-operative course of antibiotics. Arch Orthop Trauma Surg 129, 489–494 (2009). https://doi.org/10.1007/s00402-008-0683-x
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DOI: https://doi.org/10.1007/s00402-008-0683-x