Prosthetic Joint Infection after Total Hip Arthroplasty: Results of an Online Questionnaire about Current Diagnostic and Therapeutic Procedures in 107 German Hospitals

Abstract

Background Prosthetic hip joint infection is a common severe complication with a high socio-economic impact. The inconsistency of the available data and the absence of binding guidelines lead to a variety of diagnostic and therapeutic strategies. The aim of this study is to present the current diagnostic and therapeutic approach to treating infections after total hip arthroplasties in German hospitals, link it with current evidence, and evaluate the willingness of these hospitals to participate in prospective multicentre trials. Material and Methods An online questionnaire for digital processing was sent to hospitals performing joint replacement procedures. These institutions included district hospitals, private hospitals, non-university maximum care facilities, statutory accident insurance hospitals, and university hospitals. Results A total of 107 hospitals took part in the survey, corresponding to a response rate of 27.6%. These hospitals perform approximately 2,951 revisions of infected total hip arthroplasties per year. Two-stage revision arthroplasty is the preferred procedure after prosthetic hip infections. The algorithm proposed by Zimmerli et al. is widely recognised. There is a lack of uniformity in the key features for revision of prosthetic joint infections - long vs. short interval in case of two-stage revision, duration of intravenous and oral administration of antibiotics, cemented vs. cement-free implant procedures, and follow-up intervals after revision surgery. The willingness to participate in clinical trials is high. Conclusion The controversial data leads to multiple treatment approaches. The high willingness to participate in adequately funded clinical trials offers a potential for multicentre trials to be conducted. There is an urgent need for funding to make this research possible.