Surgical site infections after total hip arthroplasty result in decreased quality of life, increased morbidity and increased health care cost. We hypothesized that the implementation of a bundle of care for total hip arthroplasty decreases the amount of surgical site infections.

In this retrospective cohort study we investigated the implementation of this bundle in a University Medical Centre and its effect on perioperative surgical site infections after total hip arthroplasty and on incidence of hypothermia.

In 2009 the bundle of care consisting of four elements was implemented in total hip arthroplasty in our hospital; (I) perioperative normothermia, (II) hair removal before surgery, (III) the use of preoperative antibiotic prophylaxis and (IV) discipline on the operation room measured by door movements. For this study we used data from January 2010 – October 2013. We measured all parameters prospectively including surgical site infections within 6 weeks postoperatively.

In the study period a total of 585 patients received a primary total hip arthroplasty. Bundle compliance improved significantly in 3.5 years from 71.7% in 2010 to 91.6% in 2013. Postoperative hypothermia decreased from 10.5% to 8.4% (non-significant) and SSI rate from 0.9% to 0.0% (non-significant).

Implementation of this bundle of care is possible in an academic tertiary referral center. A relatively cheap solution can increase patient safety in a surgical environment. Introduction of a bundle of care resulted in a non-significant reduction of hypothermia and rate of surgical site infections in total hip arthroplasty.

This retrospective study evaluates the outcome of patients with a late infection of a cemented total hip arthroplasty (THA) treated with two-stage revision with retention of the original well-fixed femoral cement mantle.

Operation reports of all two stage revision performed in our clinic between 2009 and 2013 were reviewed (249 patients). Patients in which femoral cement mantle was retained during surgery were included (10 patients). The average age at the first stage revision procedure was 61.5 years (range 38–80). The mean follow-up period was 26 months (range 5 to 54 months). Clinical, laboratory, and radiological outcomes were evaluated.

Successful treatment of periprosthetic joint infection (PJI) was achieved in six out of 10 patients; four patients showed no signs of infection during follow-up. Two of these patients received three months of antibiotic treatment after second stage, because of positive cultures at second stage. The other two successfully treated patients showed recurrence of PJI one week after second stage. Debridement with retention of prosthesis (DAIR) was performed. Newly cultured microorganisms were successfully treated with 3 months of antibiotics.

The other four patients were considered to be failures; in three patients, the femoral cement mantle was removed after the first stage due to recurrent infection. The other failure showed a recurrent PJI after second stage. Despite DAIR and three months of antibiotic treatment, this patient is treated with suppressive antibiotics until latest follow-up.

Based on this study, results in managing an infected THA with cement-within-cement revision are disappointing. Therefore, more research is required to determine which patients are appropriate for cement-within-cement revision.