Two-stage operative strategy without local antibiotic treatment for infected hip arthroplasty: clinical and radiological outcome

Abstract

Two-stage revision hip surgery with insertion of local antibiotic carriers is the therapy of choice for infected hip arthroplasty. The disadvantages are the incalculable pharmacokinetics of the antibiotic, with the danger of resistance and sensitisation. In a retrospective study, the effectiveness of a two-stage revision strategy done without local antibiotics was to be investigated. Thirty-one patients (32 hips) after two-stage revision hip surgery for infection without local antibiotics were monitored clinically and radiologically, with a follow-up of 41.3 months. Nine re-debridements in combination with a systemic antibiosis had to be conducted for eradication of the infections after explantation. Reconstruction of the majority of the hips was possible without the use of revision implants and without using large structured allografts. The re-infection rate was 6.3%, the patients achieved a Harris hip score of 75.4 (range 36.1-97.0) points at the latest follow-up, and the average difference in leg length was -0.7 (range -4.5 to + 2.5) cm. Two-stage revision of the hip can be conducted without local antibiotic application, to achieve a comparatively efficient cure of the infection and function. This investigation underlines the significance of radical surgical debridement. The optional use of more effective antibiotic carriers may reduce the number of re-debridements in the future.