We have prospectively studied the outcome of infections associated with implants which were retained and treated using a standardised antimicrobial protocol. Over a period of four years, we studied 24 consecutive patients who had symptoms of infection for less than one year, a stable implant, no sinus tract and a known pathogen which was susceptible to recommended antimicrobial agents. The infections involved hip prostheses (14), knee prostheses (5), an internal fixation device (4), and an ankle prosthesis (1).

Twenty patients had a successful outcome at a median follow-up of 3.7 years (1.8 to 4.7); four had failure of the implant after a median follow-up of 1.2 years (0.3 to 2.5). The probability of survival without failure of treatment was 96% at one year (95% confidence interval (CI) 88 to 100), 92% at two years (95% CI 80 to 100) and 86% at three years (95% CI 72 to 100).

Patients with a short-term infection but with a stable implant, no sinus tract and a known pathogen may be successfully treated by retention of the implant and the use of a standardised regimen of antimicrobial treatment.

Introduction: Standard therapy for orthopedic device infections includes a two-stage exchange and prolonged antimicrobial therapy. In a subgroup of patients, retention of the device seems to be an effective alternative. Methods: In a prospective study we evaluated treatment efþcacy of orthopedic device infections with implant retention. Inclusion criteria were: early manifestation, stable implant, known pathogen, susceptibility of staphylococci to quinolones and rifampin, good condition of soft tissue. Initially, intravenous antimicrobial therapy was given for 2 weeks, followed by oral treatment for 10 weeks (knee prostheses for 6 months). Results: From January 1999 through June 2002, 19 patients were included: hip prosthesis (9), knee prostheses (6) and internal þxation devices (4). Isolated pathogens were: staphylococci (14), streptococci (4), enterococci (1), and Propionibacterium acnes (1). Open debridement with device retention was performed in 13 patients; the remaining 6 patients were treated with antibiotics only. After initial 2-week intravenous therapy, staphylococcal infections were treated with oral ciproßoxacin 750 mg bid + rifampin 450 mg bid, streptococcal and enterococcal infections with oral amoxicillin 750 mg tid and the P. acnes-infection with oral clindamycin 600 mg tid. 12 of 16 patients were followed for at least 24 months. 10 (83%) had no symptoms or signs of infection at follow-up, 2 (17%) had a relapse Conclusion: In carefully selected patients, device retention with antimicrobial treatment for 3–6 months may be an effective approach.