2019 Volume 38 Issue 1 Pages 9-16
Background: Two-stage revision is the current gold standard for the treatment of periprosthetic joint (PPJ) infection. However, treatment strategies of the two-stage revision process remain controversial. Specifically, the duration of the antibiotic-laden free period, reimplantation timing, and antibiotic administration vary among surgeons.
Design: We have treated periprosthetic hip infections using our hospital’s protocol since 2004. This study aimed to investigate the clinical results and validity of our treatment strategies during two-stage revision for PPJ infection.
Methods: Twenty patients with PPJ hip infection were treated with two-stage revision. In the first stage, all components were removed and radical debridement was performed. Antibiotic-loaded cement spacers or beads were then inserted. Intravenous antibiotics and rifampicin were administered for three weeks. After infection suppression was confirmed, revision total hip arthroplasty was performed. Intravenous antibiotics and rifampicin were administered again for three weeks, and then rifampicin and minomycin were continued for at least three months. The interim interval and clinical outcomes were investigated.
Results: Seven antibiotic-resistant microorganisms were identified, and all patients were treated using the same protocol. The mean interim interval was 8.4 weeks. Infection recurred in one hip six months after the revision. The remaining hips were ultimately reimplanted without infection. The clinical outcomes were not affected by infection onset, microorganism type, or reconstruction method.
Conclusion: After radical debridement and the use of antibiotic-loaded cement spacers or beads combined with three-weeks of intravenous antibiotic therapy and rifampicin administration, 19 hips (95%) were successfully treated for acute or chronic infections, as well as for antibiotic-sensitive or antibiotic-resistant microorganism infections, respectively. The mean interim interval was 8.4 weeks.
