Infected total hip arthroplasty treated by an irrigation-debridement/component retention protocol. A prospective study in a 12-case series with minimum 2 years’ follow-up
S. Klouche 
, L. Lhotellier, P. Mamoudy
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Summary
Introduction
Treatment of infection after total hip replacement (THR) is complex and costly. Debridement with component retention is an attractive solution. Success rates in the literature vary widely (18–90%) according to patient selection criteria. The present prospective study assessed the selection criteria used in our department.
Methods
A prospective study included all patients (n=210) surgically managed for infection following THR between November 2002 and December 2008. Patients underwent debridement in case of acute infection: i.e., early postoperative infection within 1 month of THR, or secondary hematogenic infection with less than 2 weeks’ evolution. Beyond this deadline or in case of implant loosening, implant replacement was performed. The debridement series thus comprised 12 patients (mean age, 69±11.3years; mean evolution from contamination was 4.8±3.5days). Bacteriologically adapted antibiotherapy was administered for 6weeks intravenously followed by 6weeks per os. Mean follow-up was 40±23 months. No patient was lost to follow-up. The success criterion was apparent eradication of infection at a minimum 2years, defined by absence of clinical, biological or radiological signs of infection and of death attributable to infection or treatment. Where infection was suspected, hip aspiration or peroperative sampling determined recurrence (identical bacterium) or reinfection (different bacterium).
Results
There were nine cures (75%) and three failures. Mean Postel Merle d’Aubigné Score, at end of follow-up, was 17±2. The three failures involved the same bacteria (two streptococci [one group B, one group G] and one Enterococcus faecalis) as implicated in the primary infection.
Discussion
The present results are comparable to those in the literature but poorer than for implant exchange. The technique remains, however, an interesting alternative, allowing less complex surgery and lower cost.
Conclusion
Patient selection criteria need refining so as to increase success rates with this technique.
Level of evidence
Level IV; prospective non-randomized non-comparative study.
Keywords : Debridement, Component retention, Prosthetic hip joint infection
Plan
Vol 97 - N° 2
P. 134-138 - avril 2011 Retour au numéro
Article précédent
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