TREATMENT OF THE INFECTED TOTAL HIP-ARTHROPLASTY WITH A 2-STAGE REIMPLANTATION PROTOCOL

Forty-four patients (46 hips) with infected total hip arthroplasties w ere evaluated. They were entered into a protocol that included resecti on arthroplasty, six weeks of intravenous antibiotics which obtained a minimum postpeak serum bactericidal titer of 1:8, and possible reimpl antation. Thirty-two of 46 hips (70%) were reimplanted. At an average of 40 months (range, 24-74 months) after reimplantation, infection rec urred in three hips (9%). In two of the three recurrent infections, 1: 8 bactericidal titers were not attained. Both of these hips were infec ted with gram-negative organisms. Minimum postpeak serum bactericidal titers of 1:8 were attained in 28 of 32 hips that were reimplanted, an d only one of these hips (4%) had a recurrent infection (p = 0.035). T he presence of retained cement after resection arthroplasty (ten hips) was not associated with recurrent infection. Fourteen hips (12 patien ts) were not reimplanted as a result of a combination of factors, incl uding inadequate bone stock, poor soft-tissue quality, and antibiotic resistance of the infecting organism. The treatment of an infected tot al hip arthroplasty with resection arthroplasty, six weeks of intraven ous antibiotics that attains a minimum postpeak serum bactericidal tit er of 1:8, and reimplantation can be an effective and safe treatment.