- 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