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.
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).
