Skip to main content
SpringerLink
Log in

Infection in total hip replacement: meta-analysis

  • Review
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

While total hip arthroplasty has progressed to become one of the most successful surgical procedures ever developed, infection remains a serious complication. We have conducted a review of the literature pertaining to management of deep infection in total hip arthroplasty, specifically focusing on clinically relevant articles published in the last five years. A search was conducted using MEDLINE and PubMed, as well as a review of the Cochrane database, using the terms “total hip arthroplasty”, “total hip replacement” and “infection”. References for all selected articles were cross-checked. While the so-called two-stage revision is generally considered to be the gold standard for management, numerous studies now report outcomes for implant retention and reassessing one-stage revision strategies. There are encouraging reports for complex reconstruction options in patients with associated severe bone stock loss. The duration of antibiotic therapy remains controversial. There is concern about increasing bacterial resistance especially with the widespread use of vancomycin and ertapenem (carbapenem).

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Andollina A, Bertoni G, Zolezzi C, Trentani F, Trentani P, Maria Borrelli A, Tigani D (2008) Vancomycin and meropenem in acrylic cement: elution kinetics of in vitro bactericidal action. Chir Organi Mov 91(3):153–158, Epub May 21

    Article  PubMed  Google Scholar 

  2. Anagnostakos K, Kelm J, Grün S, Schmitt E, Jung W, Swoboda S (2008) Antimicrobial properties and elution kinetics of linezolid-loaded hip spacers in vitro. J Biomed Mater Res B Appl Biomater 87(1):173–178

    PubMed  Google Scholar 

  3. Baleani M, Persson C, Zolezzi C, Andollina A, Borelli AM, Tigani D (2008) Biological and biomechanical effects of vancomycin and meropenem in acrylic bone cement. J Arthroplasty 23:1232–1238

    Article  PubMed  Google Scholar 

  4. 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

    Article  CAS  PubMed  Google Scholar 

  5. 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 87:314–319

    Article  CAS  PubMed  Google Scholar 

  6. Byren I, Bejon P, Atkins BL, Angus B, Masters S, McLardy-Smith P, Gundle R, Berendt A (2009) One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother 63:1264–1271

    Article  CAS  PubMed  Google Scholar 

  7. Cabrita H, Camargo O, Lucia Lima A, Croci A (2010) Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic loaded cement spacer. J Bone Joint Surg Br 92-B(Supp II):314

    Google Scholar 

  8. 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 

  9. Coventry MB (1975) Treatment of infections occurring in total hip surgery. Orthop Clin North Am 6:991–1003

    CAS  PubMed  Google Scholar 

  10. Disch AC, Matziolis G, Perka C (2007) Two-stage operative strategy without local antibiotic treatment for infected hip arthroplasty: clinical and radiological outcome. Arch Orthop Trauma Surg 127(8):691–697

    Article  PubMed  Google Scholar 

  11. Estes CS, Beauchamp CP, Clarke HD, Spangehl MJ (2010) A two-stage retention débridement protocol for acute periprosthetic joint infections. Clin Orthop Relat Res 468:2029–2038

    Article  PubMed  Google Scholar 

  12. Evans RP (2004) Successful treatment of total hip and knee infection with articulating antibiotic components: a modified treatment method. Clin Orthop Relat Res 427:37–46

    Article  PubMed  Google Scholar 

  13. Fink B, Grossmann A, Fuerst M, Schäfer P, Frommelt L (2009) Two-stage cementless revision of infected hip endoprostheses. Clin Orthop Relat Res 467:1848–1858

    Article  PubMed  Google Scholar 

  14. Fitzgerald RH (1995) Infected total hip arthroplasty: diagnosis and treatment. J Am Acad Orthop Surg 3:249–262

    PubMed  Google Scholar 

  15. Ganse B, Behrens P, Benthien JP (2008) Two-stage hip revision arthroplasty: the role of the excision arthroplasty. Eur J Orthop Surg Traumatol 18(3):223–228

    Article  Google Scholar 

  16. Garvin KL, Hanssen AD (1995) Infection after total hip arthroplasty. Past, present, and future. J Bone Joint Surg Am 77:1576–1588

    CAS  PubMed  Google Scholar 

  17. Hofmann AA, Goldberg TD, Tanner AM, Cook TM (2005) Ten-year experience using an articulating antibiotic cement hip spacer for the treatment of chronically infected total hip. J Arthroplasty 20:874–879

    Article  PubMed  Google Scholar 

  18. Hsieh PH, Shih CH, Chang YH, Lee MS, Yang WE, Shih HN (2005) Treatment of deep infection of the hip associated with massive bone loss: two-stage revision with an antibiotic-loaded interim cement prosthesis followed by reconstruction with allograft. J Bone Joint Surg Br 87:770–775

    Article  PubMed  Google Scholar 

  19. Hsieh PH, Huang KC, Lee PC, Lee MS (2009) Two-stage revision of infected hip arthroplasty using an antibiotic-loaded spacer: retrospective comparison between short-term and prolonged antibiotic therapy. J Antimicrob Chemother 64(2):392–397

    Article  CAS  PubMed  Google Scholar 

  20. Hsieh PH, Shih CH, Chang YH, Lee MS, Shih HN, Yang WE (2004) Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am 86:1989–1997

    PubMed  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. Jung J, Schmid NV, Kelm J, Schmitt E, Anagnostakos K (2009) Complications after spacer implantation in the treatment of hip joint infections. Int J Med Sci 6(5):265–273

    PubMed  Google Scholar 

  23. Koo KH, Yang JW, Cho SH, Song HR, Park HB, Ha YC, Chang JD, Kim SY, Kim YH (2001) Impregnation of vancomycin, gentamicin, and cefotaxime in a cement spacer for two-stage cementless reconstruction in infected total hip arthroplasty. J Arthroplasty 16:882–892

    Article  CAS  PubMed  Google Scholar 

  24. Kraay MJ, Goldberg VM, Fitzgerald SJ, Salata MJ (2005) Cementless two-staged total hip arthroplasty for deep periprosthetic infection. Clin Orthop Relat Res 441:243–249

    Article  PubMed  Google Scholar 

  25. Leunig M, Chosa E, Speck M, Ganz R (1998) A cement spacer for two-stage revision of infected implants of the hip joint. Int Orthop 22:209–214

    Article  CAS  PubMed  Google Scholar 

  26. Lieberman JR, Callaway GH, Salvati EA, Pellici PM, Brause BD (1994) Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol. Clin Orthop Relat Res 301:205–212

    PubMed  Google Scholar 

  27. Masri BA, Panagiotopoulos KP, Greidanus NV, Garbuz DS, Duncan CP (2007) Cementless two-stage exchange arthroplasty for infection after total hip arthroplasty. J Arthroplasty 22:72–78

    Article  PubMed  Google Scholar 

  28. McKenna PB, O’Shea K, Masterson EL (2009) Two-stage revision of infected hip arthroplasty using a shortened post-operative course of antibiotics. Arch Orthop Trauma Surg 129:489–494

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  30. Penner MJ, Masri BA, Duncan CP (1996) Elution characteristics of vancomycin and tobramycin combined in acrylic bone-cement. J Arthroplasty 11:939–944

    Article  CAS  PubMed  Google Scholar 

  31. Romanò CL, Romanò D, Logoluso N, Meani E (2010) Long-stem versus short-stem preformed antibiotic-loaded cement spacers for two-stage revision of infected total hip arthroplasty. Hip Int 20(1):26–33

    PubMed  Google Scholar 

  32. Rudelli S, Uip D, Honda E, Lima ALLM (2008) One-stage revision of infected total hip arthroplasty with bone graft. J Arthroplasty 23:1165–1177

    Article  PubMed  Google Scholar 

  33. Scharfenberger A, Clark M, Lavoie G, O’Connor G, Masson E, Beaupre LA (2007) Treatment of an infected total hip replacement with the PROSTALAC system. Part 1: infection resolution. Can J Surg 50:24–28

    PubMed  Google Scholar 

  34. Schröder J, Saris D, Besselaar PP, Marti RK (1998) Comparison of the results of the Girdlestone pseudoarthrosis with reimplantation of a total hip replacement. Int Orthop 22:215–218

    Article  PubMed  Google Scholar 

  35. Seldes RM, Winiarsky R, Jordan LC, Baldini T, Brause B, Zodda F, Sculco TP (2005) Liquid gentamicin in bone cement: a laboratory study of a potentially more cost-effective cement spacer. J Bone Joint Surg Am 87(2):268–272

    Article  PubMed  Google Scholar 

  36. Soriano A, García S, Bori G, Almela M, Gallart X, Macule J, Sierra J, Martínez JA, Suso S, Mensa J (2006) Treatment of acute post-surgical infection of joint arthroplasty. Clin Microbiol Infect 12:930–933

    Article  CAS  PubMed  Google Scholar 

  37. 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

    Article  CAS  PubMed  Google Scholar 

  38. Toms AD, Davidson D, Masri BA, Duncan CP (2006) The management of peri-prosthetic infection in total joint replacement. J Bone Joint Surg Br 88:149–155

    CAS  PubMed  Google Scholar 

  39. Trebse R, Pisot V, Trampuz A (2005) Treatment of infected retained implants. J Bone Joint Surg Br 87(2):249–256

    Article  CAS  PubMed  Google Scholar 

  40. 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 78:512–523

    CAS  PubMed  Google Scholar 

  41. 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 91:44–51

    CAS  PubMed  Google Scholar 

  42. Winkler H, Stoiber A, Kaudela K, Winter F, Menschik F (2008) One stage uncemented revision of infected total hip replacement using cancellous allograft bone impregnated with antibiotics. J Bone Joint Surg Br 90:1580–1585

    Article  CAS  PubMed  Google Scholar 

  43. Yamamoto K, Miyagawa N, Masaoka T, Katori Y, Shishido T, Imakiire A (2009) Cement spacer loaded with antibiotics for infected implants of the hip joint. J Arthroplasty 24:83–89

    Article  PubMed  Google Scholar 

  44. Yoo JJ, Kwon YS, Koo KH, Yoon KS, Kim YM, Kim HJ (2009) One-stage cementless revision arthroplasty for infected hip replacements. Int Orthop 33:1195–1201

    Article  PubMed  Google Scholar 

  45. Younger ASE, 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  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Middlemore Hospital, South Auckland Clinical School, University of Auckland, Private Bag, 93311, Auckland, New Zealand

    Surendra Senthi & Rocco P. Pitto

  2. Department of Orthopaedic Surgery, Auckland Hospital, University of Auckland, Auckland, New Zealand

    Jacob T. Munro

Authors
  1. Surendra Senthi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jacob T. Munro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rocco P. Pitto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rocco P. Pitto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Senthi, S., Munro, J.T. & Pitto, R.P. Infection in total hip replacement: meta-analysis. International Orthopaedics (SICOT) 35, 253–260 (2011). https://doi.org/10.1007/s00264-010-1144-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-010-1144-z

Keywords

Search

Navigation