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Infected THR – Debridement and Retention of Components:

- Discussion: (see bacterial menu
          - see debridement and washout of infected TKR
          - success rate can be as high a 71% in well selected patients;
          - criteria include acute infection (symptoms less than 1 month) in THR that have been inserted either acutely or years in the past;
          - debridement includes exchange of the polyethylene liner, which gives better access of the components; 
          - need for tissue biopsy cultures from the component membrane interface
                  - remember that in the case of biofilm, there may be minimal infection in joint fluid and capsule, and main area of infection
                           will be over the component /bone-membrane interface;
                           - ref: A comprehensive microbiological evaluation of fifty-four patients undergoing revision surgery due to prosthetic joint loosening.
          - hybrid removal of cup and liner - retention of stem:
                   - ref:  Retaining well-fixed stem in the treatment of infected THA. Good results in 19 patients followed for mean 4 years

          - antibioics:  (see local antibiotic infusion into joints)
                   - following the debridement, antibiotics must be continued for atleast 6 weeks; 
          - references: 
                  - Methylene Blue–Guided Debridement as an Intraoperative Adjunct for the Surgical Treatment of Periprosthetic Joint Infection
                  - Prolonged suppression of infection in total hip arthroplasty
                  - Long-term suppression of infection in total joint arthroplasty.
                  - Infection after Total Hip Arthroplasty. A Study of the Treatment of One Hundred and Six Infections.  
                  - Suppressive antibiotic therapy in chronic prosthetic joint infections
                  - Treatment of infected retained implants 
                  - Treatment of infection with débridement and retention of the components following hip arthroplasty.    
                  - Conservative medical therapy of prosthetic joint infections: retrospective analysis of an 8-year experience.
                  - Successful treatment of Staphylococcus epidermidis hip prosthesis infection with oral linezolid
                  - Corynebacterium jeikeium prosthetic joint infection: Case report and literature review
                  - Deep-wound infection after total hip replacement under contemporary aseptic conditions
                  - Infection Control Rate of Irrigation and Débridement for Periprosthetic Joint Infection
                  - Surgical procedures in the treatment of 784 infected THAs reported to the Norwegian Arthroplasty Register
                    Best survival with 2-stage exchange revision, but also good results with debridement and retention of the fixed implant
                  - Failure of Irrigation and Débridement for Early Postoperative Periprosthetic Infection 
                  - Retaining well-fixed cementless stem in the treatment of infected hip arthroplasty

Categories Hip