TREATMENT OF INFECTED TOTAL HIP PROSTHESE S

With a median follow-up of 8 (1-13) years in our series, we are famili ar with the entire courses in 62 infected hip arthroplasties, treatmen t starting between 1980 and 1986. The primary treatment was debridemen t with suction/irrigation in 6 cases, one-stage replacement of the pro sthesis in 32 occasions and two-stage replacement in 23 cases. Only on e definitive Girdlestone procedure was done. With further operations s uccessful healing was finally achieved in all 62 hips. In 74 % healing was primary, this being the case in 91 % (10/11) of early and 71% (36 /51) of late infections. Device-retaining procedures can be tried, par ticularly in early infections with low-virulence bacteria and a stable implant. One-stage revisions can be done in early and late low-virule nce infections with lessening of components if bone and soft tissue ar e in good condition. In all other situations a two-stage procedure is recommended. As a rule, reimplantation can be done within 2 weeks. In cases with recurrent infection, replacement should be delayed for seve ral months. As an alternative, several open debridements with reimplan tation of a new prosthesis after 2 weeks can be considered. Girdleston e resection arthroplasty should be avoided whenever possible. Antimicr obial treatment is of great importance: it should be maintained for at least 3 months and in any case until 1 month after normalization of l aboratory and clinical signs of infection.