Closed subfascial v.a.C.-therapy in periprosthetic hip infections

Abstract

Infections after hip arthroplasty can lead to protracted and complicated treatments. A great problem is thereby the persistant secretion after surgical revision. 8 patients (3 x after acetabulum cup replacement, 2 x after Girdlestone hip, 2 x after spacer implantation and one case of rearthroplasty) have been treated with a V.A.C.-therapy after bacterial infection and persistant wound secretion. In all cases a pathogen organism could be identified during the frustrated attempts of sanitation. After meticulous debridement and jet lavage in each case, 1-3 polyvinyl sponges have been placed either periprosthetic or in the resection cavity with a transcutan tube outgoing. The wounds have been closed in layers. Initially a pressure of 200 mm Hg via V.A.C. has been attached. After 48-72 h an alteration from haemorrhagic to serous secret could be observed and afterwards the pressure has been reduced to 150 mm Hg. After a mean period of 11 days (8-13) the infection parameters have been retrogressive, the wound secretion was obviously reduced and the sponges were removed. During the remaining hospitalization of each patient no complications occured. In the mean follow-up of 21 months (2-46) no reinfections have been observed. Although the V.A.C.-therapy does not count to the primary therapy concepts of periprosthetic hip infections, it stands for an effective therapy option in exclusive cases.