INFECTIONS IN TOTAL HIP PROSTHESES: A PROTOCOL FOR TREATMENT

Abstract

Introduction and purpose: Infections of total hip prostheses are one of the most serious complications that beset this procedure. Their incidence in the world literature is of 1%. However this figure rises to 16% in the case of implants secondary to fractures in patients with multiple pathologies. In this study we conduct a descriptive analysis of the qualitative variables after the implementation of an action protocol to address this complication.

Materials and methods: A consecutive series of 694 patients was studied (420 females, 60.52%, and 274 males, 39.48%). Out of these 233 cases were secondary to fractures ( 60 males and 173 females), which meant that treatment was administered as an emergency (in the first 48 hours), and 461 were primary (241 males and 247 females). The variables related to an infection risk were studied, a distinction being made between an acute and a chronic infection based on CCD criteria. In acute cases, surgical cleaning was performed; in subacute cases, a two-stage replacement was chosen and for chronic infections we performed a resection arthroplasty if the two-stage replacement failed.

Results: We performed a frequency and exponential chi square study which yielded 37 cases (5.33%) of implant infection (11 males, 26 females).The most frequently isolated germ was Staphilococus Aureus. 74% of cases treated with surgical cleaning after a diagnosis of acute infection are now infection-free after a two-year follow-up. 60% of subacute cases, where a two-stage replacement was performed, show a satisfactory result. As regards resection arthroplasty, the success of treatment was around 92%,with a p< 0.005 value.

Conclusions: Careful patient selection and early diagnosis are fundamental to obtain good results in the treatment of THP infections.