Abstract
The optimal duration of systemic antibiotic therapy in patients with prosthetic hip infection (PHI) undergoing staged exchange arthroplasty (SEA) has not been determined. We hypothesized that with an antibiotic-loaded cement spacer (ALCS), in the interim, short-term antibiotic therapy is as effective as a conventional prolonged treatment course. We reviewed 99 patients with PHI who were managed with SEA using an ALCS from February 2002 to October 2005. A standard (4-6 week) antibiotic treatment course was administered in the first 46 patients and a short-term (1 week) therapy was adopted in the subsequent 53 patients. Eight patients (four in each group) had persistent infection following the first attempt of surgery and antibiotic treatment; in three of them the infection was cured by additional debridement prior to re-implantation. Forty-two (91%) patients in the long-term group and 47 (89%) patients in the short-term group were free of infection (P = 0.67) at an average follow-up of 43 months (range, 24-60 months). Five (11%) patients developed complications related to prolonged antibiotic therapy. The short-term treatment resulted in a shorter hospital stay (18 versus 43 days, P < 0.001) and a lower direct medical cost (US$13 732 versus US$21 756, P < 0.001). Short-term antibiotic therapy was not associated with a higher rate of treatment failure. Given the higher costs and incidence of complications, protracted courses of antibiotic administration may not necessarily be routine practice in patients with PHI undergoing SEA, provided that an ALCS is used.
Highlights
Deep infection at the site of a joint implant is a devastating complication, typically resulting in painful disability, prolonged hospital stay and increased medical expenses.[1]
Debridement alone and one-stage revision have gained some success in selected cases, the current standard surgical procedure in managing prosthetic hip infections (PHIs) is staged exchange arthroplasty (SEA), involving removal of all components with thorough debridement of the infected tissues, followed by a period of antibiotic treatment and re-implantation of a new prosthesis at a later stage.[2]
Two patients suffered periprosthetic fractures of the femur after re-implantation and required further fracture repair surgery. These patients thereafter recovered without further incident. This investigation is the first to compare the outcomes of short-term and prolonged antibiotic therapy in patients with an infected hip arthroplasty treated by using SEA with an interim antibiotic-loaded cement spacer (ALCS)
Summary
Deep infection at the site of a joint implant is a devastating complication, typically resulting in painful disability, prolonged hospital stay and increased medical expenses.[1] Treatment of such infection usually involves surgery and antimicrobial therapy. Debridement alone and one-stage revision have gained some success in selected cases, the current standard surgical procedure in managing prosthetic hip infections (PHIs) is staged exchange arthroplasty (SEA), involving removal of all components with thorough debridement of the infected tissues, followed by a period of antibiotic treatment and re-implantation of a new prosthesis at a later stage.[2] The application of an antibiotic-loaded cement spacer (ALCS) in the interim between the stages has become a common approach. SEA has been successful, the optimal duration of systemic antibiotic therapy between stages has not been established. Reported durations vary significantly among studies, ranging from several days to months, with a 6 week period being the most common.[3,4,5,6,7] most authors adopted a strict
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
