Aims: Infection of total hip replacement still is considered a devastating complication. One stage revision, meaning removal of implant and debris together with insertion of a new prosthesis during the same operation, reduces rehabilitation time and costs. To overcome the disadvantages of using cement, uncemented techniques seem to be favourable.
Methods: After removal of the implants debridement is performed as in conventional septic surgery. After thorough cleaning and rinsing, bone voids are filled with bone graft using an impaction technique. We use cancellous bone that is free from antigenic material but intact structures concerning collagen and mineral content. The bone is impregnated with high loads of antibiotic, using a proprietory incubation technique. There are two options of antibiotic impregnation: vancomycin or tobramycin. The impregnation procedure guarantees high levels of antibiotics at the grafting site for several weeks during which the antibiotic is released into the surrounding. Systemic drug levels usually are undetectable. Consequently an uncemented prosthesis is inserted. Wounds are drained and closed immediately, rehabilitation is performed as after non-septic surgery.
Between 1996 and 2003 35 patients have been revised because of culture proven infection of a hip endoprostheses. All hips could be followed with a minimum of 3months and a maximum of 6years.
Results: Wound healing was uneventful in all cases. Mean hospital stay was 16days (10–32days). In three hips there was recurrence of the infection, diagnosed between 6 and 12 weeks after surgery. One could be successfully re-operated using the same technique, the other two were converted to a girdlestone situation. All other 32 hips showed no sign of infection until the last follow up.
Conclusion: One stage non-cemented revision may provide an excellent solution for infected total hip replacement. However, several principles need to be observed. Bone processed in an adequate way represents an excellent carrier for vancomycin and tobramycin. Using an antibiotic graft compound eradication of pathogens, grafting of defects and re-insertion of an uncemented prosthesis may be accomplished in a one stage procedure. Since the graft gradually is replaced by healthy own bone, improved conditions may be expected even in the case of another revision.
