Abstract
One of the most serious complications of THA is deep infection.
Charnley realised the problem. This led to the development of clean air enclosure, total body exhaust suits and the introduction of the instrument tray system. Subsequently antibiotics were used both systematically and also as an addition to the acrylic cement. Occasional deep infection requires further intervention, either by removing the implant, or performing one or two stage revision. It has been the senior author’s practice to undertake one-stage revision provided the bone stock was of sufficiently good quality to ensure reasonable quality of component fixation. The technique is based on the accepted principle of infection management: Removal of all foreign body material and infected tissues, application of local antiseptics/antibiotics, closure of cavities, ensuring stability, drainage, rest, continuation of antibiotics.
Between January 1974 and December 2001, 185 one-stage revisions were carried out by the senior author: 162 had a minimum follow-up of 5 years with a mean of 12.3 years (5.1–27.6 years). 138 cases (85.2%) were free from infection. Presence of a sinus at revision did not affect the outcome adversely – on the contrary – 90.4% were infection free as compared with 82.7% of those without a sinus.
Attention to detail was the essential part of the operation.
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