The experience that we gathered using uncemented stems for revisions with diaphyseal anchorage gave us satisfactory outcomes both for survival curve

(94% of cases – 15 yrs follow-up) and for clinical results in the aseptic mobilisations.

Thus, we extended this technique in the re-implant of septic prostheses.

We treated 43 cases of septic hip prostheses from 2003 to 2006. The treatment of choice has been the two-stage revision with the implant of temporary spacer, utilising the one-stage treatment just in few cases selected from needle-aspiration positive culture. The technique foresees the utilisation of Wagner uncemented revision stems in 98% of cases and 2% using a first implant prosthesis. Accompaniment antibiotic protocol has been protracted for 3 – 6 months till the negativity of the inflammation index.

Average follow-up of 26 months shows good clinical and radiographical results with percentage of a new revision of the two-stage in 2.32% (1 case).

The uncemented components are confirmed to be the best presidia for the implant stability retrieval in the immediate and long-term either, the two-stage strategy appears sure enough for the re-infections control especially associated with an adequate antibiotic treatment. Therefore, the choice strategy proposed by us favours the uncemented implants in combination with the two-stage.

Background: In recent years there has been an increase in the insertion of prosthetic devices in orthopaedics. In spite of improvements in surgical techniques and antibiotic prophylaxis, the absolute number of infectious complications is high. Infections have a negative impact in patient’s quality of life and have high costs of management.

Patients and Methods: Retrospective analysis of diagnosis, aetiology, and therapy of prosthetic devices infections observed from 1985 to 1999 in the operative unit for diagnosis and treatment of Infections in orthopaedics of Ospedale S. Corona- Pietra Ligure (SV).

Results: During the study period, 251 patients with infected hip prosthesis and 133 with infected knee prosthesis had been treated. Diagnosis of infection was made by means of clinical features supported by x-ray, MRI, CT scan, ultrasonography and radio-nuclide scan. Aetiology was established by microbiological culture and histology. The majority of cases were single agent infections due to Gram-positives, especially S. aureus and S epidermidis, isolated in 41% of hip and 53% of knee prosthesis infection, while P. aeruginosa represented the most frequently isolated Gram-negative (3% in hip prosthesis and 10.6 % in kne prosthesis).

Polymicrobial infections (with constant presence of S. aureus and/or S. epidermidis) accounted for 8% of hip and 7% of knee prosthesis infections. Treatment was represented by prolonged antibiotic administration (at least 8 weeks) associated with surgical debridment inacute infections, and two-stage exchange in chronic infections. In 23 hip infections in patients in poor clinical conditions or in suspected persistence of latent infection a new prosthesis was not replaced and Girdlestone’s hip arthroplasty was performed.

Conclusions: Gram-positives are the main cause of orthopaedic infections but Gram-negatives, especially P aeruginosa, are often isolated. The treatment must necessarily be combined: antibiotic therapy and surgical treatment. Only in presence of optimal conditions a new prosthesis can be replaced.