S07.1 TREATMENT OF INFECTED THR: ALGORITHM UND CLINICAL RESULTS OF OUR PATIENTS IN THE YEARS FROM 2006 TO 2008

Abstract

We want to show our results of infected THR in the years from 2006 to 2008. We use an algorithm similar to Mc Phersons’s:

In early cases with not affected surrounding tissue we prefer the one stage procedure:

When there are no radiolucent lines in X-ray und the Scan does not show any tracer enhancement we perform synovectomy and replacement of the poly liner.

If soft tissue does not have an inflammation and only the bony bed is affected, we perform a one stage procedure with use of antibiotic augmented morcelliced bone graft. We use freeze-dried cancellous bone granula from a commercial tissue bank which are bathed for 30 minutes in a combination of Tobramycin and Vancomycin which is placed into the interface of implant and bony bed.

In chronic cases with affected soft tissue we treat the patient with a two stage exchange by use of a so called intermediate spacer and the definite revision after 3 months. The intermediate spacer contains a stainless steel rod coated by Gentamicin bone cement (Tecres company) in the shape of a prosthesis. This provides the release of antibiotics into the surrounding tissue.

We treated 36 patients:

• 18 patients were treated by use of a single procedure and 15 could be healed in 5 cases we could heal the patients by synovectomy and change of the poly liner.

• 10 cases could be healed by a THR revision with antibiotic augmented morcelliced bone graft

• in two cases a two stage treatment was necessary after a synovektomie and change of poly liner

• one patient was treated by synovektomy first, after persistent inflammation a THR Revision with antibiotic augmented morcelliced bone graft was performed and finally she could be healed by a two stage procedure

• 20 patients were treated by a two stage THR with an intermediate spacer

• 17 patients could be healed (three cases included from failed single procedure group)

• 3 patients are changed to a Girdlestone Hip (one died by reason of neoplasma, one could not be healed despite 4 revision with spacer, one could not be operated as he had chronic cardiac disease and ~prostatae)

• 1 patient get a permanent head-spacer as the femur prosthesis (Lord) could not be revised based on cardiac and pulmonary disease

Using Mc Pherson’s algorithm we could be successful with a single stage procedure in 15 from 18 cases. The remnant three patient could be healed by a two stage procedure. Only 4 patient could not be healed by a two stage procedure which was performed for 20 times. As we were successful too in three cases by treating chronic periprosthetic hip infection with a single procedure by using antibiotic augmented bone granula, investigation are requested to prove if this procedure could be postulated for all chronic periprothetic infections too.