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The Journal of Bone and Joint Surgery, Vol 65, Issue 9 1256-1265, Copyright © 1983 by Journal of Bone and Joint Surgery, Inc
Total hip replacement in the previously septic hip
DL Cherney and HC Amstutz
Total hip replacement was performed in either one or two stages in
thirty-three hips with active sepsis. The sepsis had followed
hemiarthroplasty in six hips, open reduction with internal fixation of a
fracture in eight, cup arthroplasty in one, and total hip replacement in
eight hips within six years prior to the second total hip replacement. Ten
additional patients had total hip replacement following destruction of the
hip joint by hematogenous sepsis in nine and by infection following a
shrapnel wound in one. Of these thirty-three patients, twenty-three (70 per
cent) reveal no signs of infection at three to nine years after prosthetic
replacement. Of the remaining ten in whom an infection developed, six had
definite recurrences of the original infection, three were infected with
organisms different from the original one, and one was either a local
recurrence or reseeding from a persistent pyelonephritis. The success rate
when the original organism was gram-positive was 78 per cent, including two
of three total hip replacements done in the presence of active infection
with Staphylococcus epidermidis. The success with gram-negative organisms,
however, was only 58 per cent. The prosthetic failure rate was highest in
patients who had had a previous infection about a total hip replacement (37
per cent) and in patients who had had a previous infection but no prior
prosthetic or internal fixation devices (37 per cent). The lowest
prosthetic failure rates were in patients with an infected hemiarthroplasty
(16 per cent), an infection around an internal fixation device (25 per
cent), or an infected cup arthroplasty. A complete and differential
blood-cell count, erythrocyte sedimentation rate, aspiration arthrogram,
and radiographs did not effectively predict success or failure. For
gram-positive infections, the success rates were similar following either a
one or a two-stage procedure. We found that the success rates could be
improved by a repeat course of parenteral antibiotics after the total hip
replacement even if all preoperative and intraoperative studies failed to
identify an infection. Patients with a successful total hip replacement
achieved much better functional results than those who had to have a
Girdlestone procedure. However, all patients must be carefully assessed
prior to reimplantation of a prosthesis because of the high failure rate,
especially with gram-negative organisms (Pseudomonas having the gravest
prognosis), even when the procedure is done in two stages.(ABSTRACT
TRUNCATED AT 400 WORDS)
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