Successful treatment of prosthetic joint infections (PJIs) requires surgical intervention and prolonged antimicrobial therapy (AT), although the most suitable management has not been clearly defined yet. The aim of the study is to review our experience in the management of AHPJIs.

From 01/01/2004 to 31/12/2006 all patients with PJIs were prospectively evaluated in 8 Spanish hospitals by the REIPI. We focused here on AHPJIs. Diagnostic of infection was based on clinical-microbiological evidence.

Forty-nine patients, 30 (61.2%) women, median age: 75.35 years (range: 31–92), were diagnosed of AHPJIs: 22 (44.8%) hips, 26 (53%) knees and 1 (2%) elbow implants. Following total joint replacement our patients had a median infection-free period of 4.9 years (range 0.3 to 18.7). The comorbidities were: 9 (18.3%) rheumatoid arthritis, 7 (14.3%) diabetes, and 6 (12.2%) chronic renal failure. Clinical features were acute in all cases: pain 100%, inflammatory signs 75.5%, and fever 70%. In 27 (55%) of the cases a distant previous infection caused by the same microorganism could be identified. The etiology was: S. aureus 18 (36.7%), streptococcal infections 13 (26.5%), coagulase-negative staphylococci 2 (4%), gram-negative bacilli 11 (22.4%), anaerobes 2 (4%), and mixed infections in 3 (6.1%) cases. Thirty (61.1%) patients underwent early drainage/debridement with retention of the implant, 11 (22.4%) two-stage replacement, 6 (12.5%) arthrodesis, 1 (2.1%) resection arthroplasty, and 1 unknown. Patients were treated with specific AT (median duration of 10.6 weeks) according to the isolated microorganism. At 1 year follow-up 25 (51%) were cured, 7 (14.3%) relapsed after a conservative approach (3 required an arthrodesis and 1 a two-stage replacement), 5 (10.2 %) died and 5 (10.2%) had a re-infection; in 7 the evolution was unknown.

AHPJs can be successfully treated in most cases with surgical debridement plus an antibiotic course. If a relapse is observed, removal of the prostheses could be necessary.

Introduction and Objectives: This is a prospective analysis of clinical and radiographic outcomes of total hip prosthesis with alumina-on-alumina friction coupling implants performed at two hospitals.

Materials and Methods: This study analyzes 60 prostheses with alumina-on-alumina friction coupling (Ceraver-Osteal) (May 1999-May 2002). The Cerafit cup was used in association with 32 Multicone-HAC stems and 28 Anatomic-HAC. Of these cases, 36 were male, and 24 were female, with average age being 47.05+/−12.60 years. Mean follow-up time was 2.3 years. There were no lost or revised cases. Radiographic analysis was done according to Johnston et al., and wear was assessed using the Sychterz method in a special computer program (Auto-CAD R14).

Results: All cases had good clinical and radiographic outcomes. There were no revisions or loosening of the implants. There was one dislocation and one intraoperative fracture, which were both treated by conservative means. There were no infections. The distance between the centres of the femoral head and the cup on the initial radiograph (position zero) was 2.49+/−0.70mm. This measurement stayed constant with time, and no changes were observed associated with so-called early wear or initial seating. Mean wear with respect to a reference of position zero was 0.0184+/−0.0187. This figure is below the error level of the measuring system and thus is not measurable.

Discussion and Conclusions: The alumina-on-alumina prosthesis (Ceraver) yields positive clinical and radiographic results at 4 years. Even though the alumina partially distorts the radiographic image, no evidence of early wear due to seating of the components was observed at four years of follow up using the Sychterz digitalized method.