Abstract
Introduction: Maximum effort should be taken during surgical debridement of an infected hip arthroplasty to remove all implants and cement, as also granulation, devitalized and necrotic tissue. Nevertheless, this process is sometimes technically demanding, risky for bone stock and prolongs the procedure. Residual unremoved polymethylmethacrylate (PMMA) after the resection of infected prosthetic components constitutes a controversial issue.
Material and Methods: We analyzed 10 patients with infected total hip prosthesis that had been previously treated with resection arthroplasty and antibiotics who presented persistent infection with residual cement. In 9 patients, surgical debridement with resection of all the PMMA was performed, and adequate intravenous antibiotics were administered. One patient refused surgical treatment, but accepted antibiotics.
Results: At an average 4 (1–18) years follow-up, 8 patients evolved with no signs or symptoms of recurrent infection. One severely immunodeficient patient died 2 years after the removal of residual cement for reasons other than his hip with an intermitent fistula. The patient who refused surgical treatment continues to have an active sinus 4 years after first consultation.
Conclusions: Residual cement could be responsible for chronic infection. Resection arthroplasty as part of the treatment of an infected hip arthroplasty must be precise and thorough, and all devitalized or foreign material must be removed.
The abstracts were prepared by editorial secretary, Mrs K. Papastefanou. Correspondence should be addressed to Professor K.N. Malizos, Department of Orthopaedic Surgery, School of Medicine, University of Thessalia, Larissa, 41222 GREECE
