We evaluated the results of treatment for 97 patients (106 infections in 98 hips) who had had either an infection after a total hip arthroplasty or positive intraoperative cultures of specimens obtained during revision of a total hip arthroplasty for presumed aseptic loosening. The patients were managed according to various protocols on the basis of the clinical setting (positive intraoperative cultures, early postoperative infection, late chronic infection, or acute hematogenous infection). Aerobic gram-positive cocci accounted for 109 (74 per cent) of the 147 microbial isolates; gram-negative bacilli, for 21 (14 per cent); and anaerobes, for 12 (8 per cent). The white blood-cell count and erythrocyte sedimentation rate were elevated in association with 17 (16 per cent) and 67 (63 per cent) of the 106 infections, respectively. The mean duration of follow-up was 3.8 years (range, 0.3 to 11 years). A good result was noted after the initial treatment of 28 (90 per cent) of the 31 infections that had been diagnosed on the basis of positive intraoperative cultures at the time of the revision, 25 (71 per cent) of the 35 early postoperative infections, 29 (85 per cent) of the 34 late chronic infections, and 3 of the 6 acute hematogenous infections. Of the 20++-one infections for which the initial therapy failed, 12 eventually were eradicated after additional treatment and the hip had a functional prosthesis at the time of follow-up. Of the 97 infections that were treated successfully (there was a functional retained or exchange prosthesis in place at the time of the most recent follow-up and infection had not recurred at least 2 years after the discontinuation of antibiotic therapy), 9 were associated with subsequent aseptic loosening of the prosthesis. The factors associated with recurrent infection were retained bone cement, the number of previous operations, potential immunocompromise, and early postoperative infection after arthroplasty without cement.
Copyright remains with the authors and publisher.
We evaluated the results of treatment for 97 patients (106 infections in 98 hips) who had had either an infection after a total hip arthroplasty or positive intraoperative cultures of specimens obtained during revision of a total hip arthroplasty for presumed aseptic loosening. The patients were managed according to various protocols on the basis of the clinical setting (positive intraoperative cultures, early postoperative infection, late chronic infection, or acute hematogenous infection). Aerobic gram-positive cocci accounted for 109 (74 per cent) of the 147 microbial isolates; gram-negative bacilli, for 21 (14 per cent); and anaerobes, for 12 (8 per cent). The white blood-cell count and erythrocyte sedimentation rate were elevated in association with 17 (16 per cent) and 67 (63 per cent) of the 106 infections, respectively. The mean duration of follow-up was 3.8 years (range, 0.3 to 11 years). A good result was noted after the initial treatment of 28 (90 per cent) of the 31 infections that had been diagnosed on the basis of positive intraoperative cultures at the time of the revision, 25 (71 per cent) of the 35 early postoperative infections, 29 (85 per cent) of the 34 late chronic infections, and 3 of the 6 acute hematogenous infections. Of the 20++-one infections for which the initial therapy failed, 12 eventually were eradicated after additional treatment and the hip had a functional prosthesis at the time of follow-up. Of the 97 infections that were treated successfully (there was a functional retained or exchange prosthesis in place at the time of the most recent follow-up and infection had not recurred at least 2 years after the discontinuation of antibiotic therapy), 9 were associated with subsequent aseptic loosening of the prosthesis. The factors associated with recurrent infection were retained bone cement, the number of previous operations, potential immunocompromise, and early postoperative infection after arthroplasty without cement.
Copyright remains with the authors and publisher.