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PROLONGED COMBINATIONS OF ORAL INTRACELLULAR-EFFECTIVE ANTIBIOTICS FOR 2-STAGE EXCHANGE

7th Congress of the European Federation of National Associations of Orthopaedics and Traumatology, Lisbon - 4-7 June, 2005



Abstract

Purpose: To analyse prolonged combinations of oral intracellular-effective antibiotics plus two-stage exchange surgery for treatment of chronic THA and TKA infections.

Materials and Methods: Definition of infected case: more than 3 months from surgery; multiple positive intraoperative cultures and/or active fistulae.

33 patients were treated from 1996 to 2002: 8 THA, 5 hip hemiarthroplasties, 20 TKA.

Bacteriology: 24 Staphylococci of which 16 were methycillin-resistant, 7 multi-resistant Gram-negative, 2 Cory-nebacteriae; 7 polymicrobian.

Antibiotic therapy: two simultaneous oral antibiotics, selected according to bacterial sensitivity and intracel-lular effectiveness (rifampin, ofloxacin, ciprofloxacin, levofloxacin, trimethoprim-sulfamethoxazole, fosfomicin, linezolid, doxiciclin), were used on an outpatient basis (between 1st and 2nd surgery, and after 2nd surgery until serological normalization). Patients received intravenous antibiotics and were in-hospital only for one week after surgery.

Surgery: two-stage exchange with 2nd stage delayed until clinical and serological normalization.

Healing of infection: absence of clinical, serological and radiological evidence of infection along all follow-up.

Prospective follow-up: 24-96 months.

Results: Healing of infection: 32/33 patients (97%).

Treatment failure: 1 patient (TKA) (3%).

THA: 8/8 infections healed: 1 Girdlestone patient (1st stage of exchange) rejected reimplantation; 7 two-stage exchange (good/excellent objective and subjective result).

Hip hemiarthroplasty: 5/5 infections healed: 3 Girdlestone (1st stage of exchange surgery, 2nd stage rejected because of hemiplegia or Alzheimer); 2 two-stage exchange (good/excellent objective and subjective result).

TKA: 19/20 infections healed: 3 resection-arthroplasty (1st stage of exchange surgery, 2nd stage rejected because of Buerger, cirrhosis or Alzheimer); 17 two-stage exchange (15 good/excellent objective and subjective results, 1 patient needed a debridement 2 months after 2nd surgery because of prolonged aseptic drainage and healed uneventfully, 1 failure described).

Conclusions: Prolonged combinations of oral intracellular-effective antibiotics associated with two-stages exchange surgery is a promising alternative for treating deep chronic THA and TKA infections. Longer follow-up and larger series are necessary.

Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.