Introduction

Debridement, antibiotics, and implant retention (DAIR) for acute prosthetic hip infection is a popular low morbidity option despite less than optimal success rates. We theorized that the delay between DAIR and explantation in failed cases may complicate eradication due to biofilm maturation and entrenchment of bacteria in periprosthetic bone. We ask, what are the results of two-stage reimplantation after a failed DAIR versus an initial two-stage procedure?

Introduction. The infection rate after total joint arthroplasty (TJA) has been shown to be 1–2% in multiple series and registry data. Irrigation, debridement, and polyethylene exchange (IDPE) is a common first line treatment in many cases of acute prosthetic joint infection (PJI). The reinfection rate in open IDPE procedures is variable with studies showing reinfection rates of 10–70% depending on various patient and microbial factors. Our pilot study aimed to determine if the bacterial load in infected total joints was sufficiently reduced by IDPE to allow for the use of post-debridement cultures as an independent marker of procedural success. Methods. 46 prosthetic joint infections underwent irrigation and debridement using 6L of normal saline and 3L of a normal saline and bacitracin mixture prior to the insertion of a new polyethylene liner. This protocol utilized a single equipment setup with all surgical members donning new gloves prior to polyethylene exchange. Between 3 and 5 intraoperative cultures were obtained both prior to and after debridement as per the surgeon's standard protocol. A two-tailed student's t-test was used to evaluate for any differences in the rate of positive culture between these two groups. Results. Of all pre- and post-debridement cultures sampled 66.5% and 60.7% of cultures were positive respectively. No significant difference in the rate of positive intraoperative culture was found between pre-debridement and post-debridement groups (p = 0.52). In 32 of 46 (69%) cases there was no difference in the total number of positive cultures despite a thorough debridement. Conclusions. Our data shows that open debridement of PJI does not provide a sterile environment, and post-debridement cultures should not be used as an independent marker of procedural success. The role of an irrigation and debridement to reduce the bacterial burden and potentiate the clearance of an infection is established but its efficacy is unclear, and the inability to create a post-debridement sterile environment is a concern

The infection rate after total joint arthroplasty (TJA) has been shown to be 1–2% in multiple series and registry data. Irrigation, debridement, and polyethylene exchange (IDPE) is a common first line treatment in many cases of acute prosthetic joint infection (PJI). The reinfection rate in open IDPE procedures is variable with studies showing reinfection rates of 10–70% depending on various patient and microbial factors. Our pilot study aimed to determine if the bacterial load in infected total joints was sufficiently reduced by IDPE to allow for the use of post-debridement cultures as an independent marker of procedural success. 46 prosthetic joint infections underwent irrigation and debridement using 6L of normal saline and 3L of a normal saline and bacitracin mixture prior to the insertion of a new polyethylene liner. This protocol utilized a single equipment setup with all surgical members donning new gloves prior to polyethylene exchange. Between 3 and 5 intraoperative cultures were obtained both prior to and after debridement as per the surgeon's standard protocol. A two-tailed student's t-test was used to evaluate for any differences in the rate of positive culture between these two groups. Of all pre- and post-debridement cultures sampled 66.5% and 60.7% of cultures were positive respectively. No significant difference in the rate of positive intraoperative culture was found between pre-debridement and post-debridement groups (p = 0.52). In 32 of 46 (69%) cases there was no difference in the total number of positive cultures despite a thorough debridement. Our data shows that open debridement of PJI does not provide a sterile environment, and post-debridement cultures should not be used as an independent marker of procedural success. The role of an irrigation and debridement to reduce the bacterial burden and potentiate the clearance of an infection is established but its efficacy is unclear, and the inability to create a post-debridement sterile environment is a concern

Aims

For this retrospective cohort study, patients aged ≤ 30 years (very young) who underwent total hip arthroplasty (THA) were compared with patients aged ≥ 60 years (elderly) to evaluate the rate of revision arthroplasty, implant survival, the indications for revision, the complications, and the patient-reported outcomes.

Two-stage exchange remains the gold standard for treatment of peri-prosthetic joint infection after total hip replacement (THR). In the first stage, all components and associated cement if present are removed, an aggressive debridement is undertaken including a complete synovectomy, and an antibiotic-loaded cement spacer is put in place. Patients are then treated with six weeks of parenteral antibiotics, followed by an ‘antibiotic free period’ to help ensure the infection has been eradicated. If the clinical evaluation and serum inflammatory markers suggest the infection has resolved, then the second stage can be completed, which involves removal of the cement spacer, repeat debridement, and placement of a new THR.

Cite this article: Bone Joint J 2013;95-B, Supple A:84–7.

Arthroscopy of the native hip is an established diagnostic and therapeutic procedure. Its application in the symptomatic replaced hip is still being explored. We describe the use of arthroscopy of the hip in 24 symptomatic patients following total hip replacement, resurfacing arthroplasty of the hip and partial resurfacing (study group), and compared it with arthroscopy of the native hip in 24 patients (control group). A diagnosis was made or confirmed at arthroscopy in 23 of the study group and a therapeutic arthroscopic intervention resulted in relief of symptoms in ten of these. In a further seven patients it led to revision hip replacement. In contrast, arthroscopy in the control group was diagnostic in all 24 patients and the resulting arthroscopic therapeutic intervention provided symptomatic relief in 21.

The mean operative time in the study group (59.7 minutes (35 to 93)) was less than in the control group (71 minutes (40 to 100), p = 0.04) but the arthroscopic approach was more difficult in the arthroplasty group. We suggest that arthroscopy has a role in the management of patients with a symptomatic arthroplasty when other investigations have failed to provide a diagnosis.