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The Journal of Bone and Joint Surgery 80:961-68 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.

Direct-Exchange Arthroplasty for the Treatment of Infection after Total Hip Replacement. An Average Ten-Year Follow-up*

KEITH J. URE, M.D.{dagger}, HARLAN C. AMSTUTZ, M.D.{ddagger}, SAM NASSER, M.D.§ and THOMAS P. SCHMALZRIED, M.D.{dagger}, LOS ANGELES, CALIFORNIA

Investigation performed at the Joint Replacement Institute and the University of California, Los Angeles

Twenty consecutive patients who had a direct-exchange total hip arthroplasty, performed by one surgeon between October 1979 and July 1990, were prospectively followed and data were collected. The most common infecting organism was Staphylococcus epidermidis (nine patients), followed by Streptococcus species and Staphylococcus aureus (five patients each). Three patients (15 per cent) had a draining sinus tract at the time of the operation. The operation and the postoperative management included meticulous débridement, administration of appropriate systemic antibiotic therapy, and use of antibiotic-loaded cement. By an average of 9.9 years (range, 3.5 to 17.1 years) postoperatively, no patient had had recurrence of the infection. Two patients had a revision for aseptic loosening nine and seventeen years after the direct exchange. Although the present series is relatively small, our experience has shown that direct exchange, which is associated with less morbidity and is less expensive than delayed exchange, can be successful in carefully selected patients.


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