DIRECT-EXCHANGE ARTHROPLASTY FOR THE TREATMENT OF INFECTION AFTER TOTAL HIP-REPLACEMENT - AN AVERAGE 10-YEAR FOLLOW-UP

Twenty consecutive patients who had a direct-exchange total hip arthro plasty, performed by one surgeon between October 1979 and July 1990, w ere prospectively followed and data were collected, The most common in fecting organism was Staphylococcus epidermidis (nine patients), follo wed by Streptococcus species and Staphylococcus aureus (five patients each). Three patients (15 per cent) had a draining sinus tract at the time of the operation. The operation and the postoperative management included meticulous debridement, administration of appropriate systemi c antibiotic therapy and use of antibiotic-loaded cement. By an averag e of 9.9 years (range, 3.5 to 17.1 years) postoperatively, no patient had had recurrence of the infection. Two patients had a revision for a septic loosening nine and seventeen years after the direct exchange. A lthough the present series is relatively small, our experience has sho wn that direct exchange, which is associated with less morbidity and i s less expensive than delayed exchange, can be successful in carefully selected patients.