This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by TSUKAYAMA, D. T
Right arrow Articles by GUSTILO, R. B
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by TSUKAYAMA, D. T
Right arrow Articles by GUSTILO, R. B
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery 78:512-23 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.

Infection after Total Hip Arthroplasty. A Study of the Treatment of One Hundred and Six Infections*

DEAN T TSUKAYAMA, M.D.{dagger}, RUPERTO ESTRADA, M.D.{dagger} and RAMON B GUSTILO, M.D.{dagger}, MINNEAPOLIS, MINNESOTA

Investigation performed at Hennepin County Medical Center and Metropolitan-Mount Sinai Medical Center, Minneapolis

We evaluated the results of treatment for ninety-seven patients (106 infections in ninety-eight hips) who had had either an infection after a total hip arthroplasty or positive intraoperative cultures of specimens obtained during revision of a total hip arthroplasty for presumed aseptic loosening. The patients were managed according to various protocols on the basis of the clinical setting (positive intraoperative cultures, early postoperative infection, late chronic infection, or acute hematogenous infection). Aerobic gram-positive cocci accounted for 109 (74 per cent) of the 147 microbial isolates; gram-negative bacilli, for twenty-one (14 per cent); and anaerobes, for twelve (8 per cent). The white blood-cell count and erythrocyte sedimentation rate were elevated in association with seventeen (16 per cent) and sixty-seven (63 per cent) of the 106 infections, respectively. The mean duration of follow-up was 3.8 years (range, 0.3 to eleven years). A good result was noted after the initial treatment of twenty-eight (90 per cent) of the thirty-one infections that had been diagnosed on the basis of positive intraoperative cultures at the time of the revision, twenty-five (71 per cent) of the thirty-five early postoperative infections, twenty-nine (85 per cent) of the thirty-four late chronic infections, and three of the six acute hematogenous infections. Of the twenty-one infections for which the initial therapy failed, twelve eventually were eradicated after additional treatment and the hip had a functional prosthesis at the time of follow-up. Of the ninety-seven infections that were treated successfully (there was a functional retained or exchange prosthesis in place at the time of the most recent follow-up and infection had not recurred at least two years after the discontinuation of antibiotic therapy), nine were associated with subsequent aseptic loosening of the prosthesis. The factors associated with recurrent infection were retained bone cement, the number of previous operations, potential immunocompromise, and early postoperative infection after arthroplasty without cement.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
P. Birmingham, J. M. Helm, P. A. Manner, and R. S. Tuan
Simulated Joint Infection Assessment by Rapid Detection of Live Bacteria with Real-Time Reverse Transcription Polymerase Chain Reaction
J. Bone Joint Surg. Am., March 1, 2008; 90(3): 602 - 608.
[Abstract] [Full Text] [PDF]

Home page
 J. Bacteriol.Home page
S. Schlag, C. Nerz, T. A. Birkenstock, F. Altenberend, and F. Gotz
Inhibition of Staphylococcal Biofilm Formation by Nitrite
J. Bacteriol., November 1, 2007; 189(21): 7911 - 7919.
[Abstract] [Full Text] [PDF]

Home page
 ImagingHome page
H Marmery and S Ostlere
Imaging of prosthetic joints
Imaging, September 1, 2007; 19(3): 299 - 309.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
D. J. F. Moojen, S. N.M. Spijkers, C. S. Schot, M. W. Nijhof, H. C. Vogely, A. Fleer, A. J. Verbout, R. M. Castelein, W. J.A. Dhert, and L. M. Schouls
Identification of Orthopaedic Infections Using Broad-Range Polymerase Chain Reaction and Reverse Line Blot Hybridization
J. Bone Joint Surg. Am., June 1, 2007; 89(6): 1298 - 1305.
[Abstract] [Full Text] [PDF]

Home page
 Journal of the American Dental AssociationHome page
P. B. Lockhart, B. Loven, M. T. Brennan, and P. C. Fox
The evidence base for the efficacy of antibiotic prophylaxis in dental practice
J Am Dent Assoc, April 1, 2007; 138(4): 458 - 474.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
Q. Cui, W. M. Mihalko, J. S. Shields, M. Ries, and K. J. Saleh
Antibiotic-Impregnated Cement Spacers for the Treatment of Infection Associated with Total Hip or Knee Arthroplasty
J. Bone Joint Surg. Am., April 1, 2007; 89(4): 871 - 882.
[Full Text] [PDF]

Home page
 J Bone Joint Surg BrHome page
O. S. Schindler, R. F. Spencer, and M. D. Smith
Should we use a separate knife for the skin?
J Bone Joint Surg Br, March 1, 2006; 88-B(3): 382 - 385.
[Abstract] [Full Text] [PDF]

Home page
 Infect. Immun.Home page
U. Fluckiger, M. Ulrich, A. Steinhuber, G. Doring, D. Mack, R. Landmann, C. Goerke, and C. Wolz
Biofilm Formation, icaADBC Transcription, and Polysaccharide Intercellular Adhesin Synthesis by Staphylococci in a Device-Related Infection Model
Infect. Immun., March 1, 2005; 73(3): 1811 - 1819.
[Abstract] [Full Text] [PDF]

Home page
 J Bone Joint Surg BrHome page
R. Trebse, V. Pisot, and A. Trampuz
Treatment of infected retained implants
J Bone Joint Surg Br, February 1, 2005; 87-B(2): 249 - 256.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
C. Love, S. E. Marwin, M. B. Tomas, E. S. Krauss, G. G. Tronco, K. K. Bhargava, K. J. Nichols, and C. J. Palestro
Diagnosing Infection in the Failed Joint Replacement: A Comparison of Coincidence Detection 18F-FDG and 111In-Labeled Leukocyte/99mTc-Sulfur Colloid Marrow Imaging
J. Nucl. Med., November 1, 2004; 45(11): 1864 - 1871.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
W. Zimmerli, A. Trampuz, and P. E. Ochsner
Prosthetic-Joint Infections
N. Engl. J. Med., October 14, 2004; 351(16): 1645 - 1654.
[Full Text] [PDF]

Home page
 RadiologyHome page
K. D. M. Stumpe, H. P. Notzli, M. Zanetti, E. M. Kamel, T. F. Hany, G. W. Gorres, G. K. von Schulthess, and J. Hodler
FDG PET for Differentiation of Infection and Aseptic Loosening in Total Hip Replacements: Comparison with Conventional Radiography and Three-Phase Bone Scintigraphy
Radiology, May 1, 2004; 231(2): 333 - 341.
[Abstract] [Full Text] [PDF]

Home page
 ImagingHome page
S Ostlere and S Soin
Imaging of prosthetic joints
Imaging, December 1, 2003; 15(4): 270 - 285.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
C. J. Palestro
Nuclear Medicine, the Painful Prosthetic Joint, and Orthopedic Infection
J. Nucl. Med., June 1, 2003; 44(6): 927 - 929.
[Full Text] [PDF]

Home page
 JBJSHome page
D. T. Tsukayama, V. M. Goldberg, and R. Kyle
Diagnosis and Management of Infection After Total Knee Arthroplasty
J. Bone Joint Surg. Am., January 21, 2003; 85(90001): S75 - 80.
[Full Text] [PDF]

Home page
 JBJSHome page
C. B. Phillips, J. A. Barrett, E. Losina, N. N. Mahomed, E. A. Lingard, E. Guadagnoli, J. A. Baron, W. H. Harris, R. Poss, and J. N. Katz
Incidence Rates of Dislocation, Pulmonary Embolism, and Deep Infection During the First Six Months After Elective Total Hip Replacement
J. Bone Joint Surg. Am., January 17, 2003; 85(1): 20 - 26.
[Abstract] [Full Text] [PDF]

Home page
 RadioGraphicsHome page
C. Love, M. B. Tomas, S. E. Marwin, P. V. Pugliese, and C. J. Palestro
Role of Nuclear Medicine in Diagnosis of the Infected Joint Replacement
RadioGraphics, September 1, 2001; 21(5): 1229 - 1238.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
G. M. Robbins, B. A. Masri, D. S. Garbuz, and C. P. Duncan
Primary Total Hip Arthroplasty After Infection
J. Bone Joint Surg. Am., April 1, 2001; 83(4): 601 - 601.
[Full Text]

Home page
 JBJSHome page
H. SEGAWA, D. T. TSUKAYAMA, R. F. KYLE, D. A. BECKER, and R. B. GUSTILO
Infection After Total Knee Arthroplasty. A Retrospective Study of the Treatment of Eighty-One Infections
J. Bone Joint Surg. Am., October 1, 1999; 81(10): 1434 - 45.
[Abstract] [Full Text]

Home page
 JBJSHome page
J. R. CROCKARELL, A. D. HANSSEN, D. R. OSMON, and B. F. MORREY
Treatment of Infection with Debridement and Retention of the Components following Hip Arthroplasty
J. Bone Joint Surg. Am., September 1, 1998; 80(9): 1306 - 1313.
[Abstract] [Full Text]

Home page
 JBJSHome page
A. D. HANSSEN and J. A. RAND
Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Evaluation and Treatment of Infection at the Site of a Total Hip or Knee Arthroplasty*{{dagger}}
J. Bone Joint Surg. Am., June 1, 1998; 80(6): 910 - 22.
[Full Text]

Home page
 JAMAHome page
W. Zimmerli, A. F. Widmer, M. Blatter, R. Frei, P. E. Ochsner, and for the Foreign-Body Infection Study Group
Role of Rifampin for Treatment of Orthopedic Implant-Related Staphylococcal Infections: A Randomized Controlled Trial
JAMA, May 20, 1998; 279(19): 1537 - 1541.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
E. L. MASTERSON, B. A. MASRI, and C. P. DUNCAN
Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Treatment of Infection at the Site of Total Hip Replacement*{{dagger}}
J. Bone Joint Surg. Am., November 1, 1997; 79(11): 1740 - 9.
[Full Text]

Home page
 JBJSHome page
M. J. SPANGEHL, A. S. E. YOUNGER, B. A. MASRI, and C. P. DUNCAN
Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Diagnosis of Infection following Total Hip Arthroplasty*{{dagger}}
J. Bone Joint Surg. Am., October 1, 1997; 79(10): 1578 - 88.
[Full Text]