Background: Infection after total hip arthroplasty is a dreaded complication with an incidence of 0,5–1 % after primary interventions. The optimum treatment of deep infection remains controversial. Debridement, retention of the prosthesis and antimicrobial treatment is an attractive option of treatment for early deep infections, but this method has often been reported with poor outcome. If restricting this method to patients with a stable implant, short duration of symptoms and contained soft tissue, the success rate seems to be substantially improved. We report the outcome of early prosthetic joint infections treated with debridement and retention of components in a prospectively recorded 8-year cohort.
Materials and Methods: All elective hip arthroplasties between 1998 and 2005 were prospectively recorded as a part of a quality registration with demographic and clinical data. In the same period, we recorded 39 (24 women) consecutive patients with a mean age of 71 years (range, 32–89) who presented with an early prosthetic joint infection within one month after the index operation. Infection was clinically diagnosed and based on the CDC definition for deep incisional surgical site infection. Medical and surgical treatment were chosen individually by the treating surgeons on the basis of the different clinical settings. The primary outcome measures were clinical, radiographic and laboratory evidence of recurrent infection or revision with isolation of the initial microbial agent. All patients were followed from index operation to final clinical visit in 2008 or death. 11 patients were dead, and a chart review was then done.
Results: Staphylococcus aureus was isolated in 23/39 patients (59%). Coagulase negative staphylococci were isolated in 19 patients (49 %), of which 4 were methicillin-resistant. 15 of the infections were polymicrobial. 37 patients were treated with soft-tissue debridement, retention of the prosthesis and antimicrobial therapy. The mean duration of antimicrobial therapy was 70 days (range, 20–270). The mean duration of days after index operation until initial debridement, was 22 days (range, 11–63). At a mean follow-up of 48 months (range, 9–120), 35/37 patients had no signs of recurrent prosthetic infection. 26 infections (70,3%) were eradicated by debridement alone, 9 after additional surgery. When treated within 3 weeks after index operation, 17/23 infections were eradicated by debridement alone (73,9%).
Conclusions: The data suggests that debridement, retention of the prosthesis and antimicrobial treatment is a reasonable option for treating early prosthetic joint infection after primary hip arthroplasty. Efficacy seems higher with earlier diagnosis and treatment.
