Treatment Of Hip Infections Research Articles

Microbiological Profile of Infections of the Hip Joint: An Indian Perspective

AbstractBackground: Knowledge of the local microbiological epidemiology helps in formulating protocols for appropriate treatment of hip infections. The aim of this study was to profile the organisms cultured from infected hips. Methods: The microbiological profile and sensitivity pattern of organisms in eighty infected hips were reviewed. Results: Infection was secondary to arthroplasty in 35, fracture surgery in 34 and primary septic arthritis in 11. Twenty percent of the infections were polymicrobial, whereas the rest were monomicrobial. Fifty-five percent were Gram-positive, of which 45% were Staphylococcus species (36% methicillin-sensitive Staphylococcus aureus, 20% methicillin-resistant S. aureus, and 44% coagulase sensitive Staphylococcal species). All Staphylococcus species were sensitive to vancomycin, but 20% of Enterococcus species were resistant to vancomycin. One-third of the Enterococcus species and 2% of Staphylococcus species were resistant to teicoplanin. Escherichia coli (n = 10) and Pseudomonas sp. (n = 13) were the most common Gram-negative organism. Although 18% of the Gram-negative organisms were carbapenem resistant, all were sensitive to colistin. Conclusion:Staphylococcus sp. was the most common pathogen found in hip infections. However, the high incidence of Gram-negative infection requires that prophylactic antibiotics cover these organisms as well. The high resistance to first-line antibiotics should be taken into consideration while making protocols. The knowledge of the microbial profile is especially important when considering arthroplasty for arthritis secondary to hip infections.

Antibiotic-laden Arthroplasty with a Novel Design of Cement Mould and Metallic Endoskeleton for Treatment of Hip Infection, an Inexpensive Alternative: A Preliminary Report of Two Cases.

Infection of the hip after implant fixation is an uncommon yet devastating complication that results in poor long-term outcome. The gold standard treatment for chronic infection after hip arthroplasty is a two-stage protocol: eradication of infection, follow by re-implantation arthroplasty. The use of interim antibiotic-laden cement spacer has become a popular procedure to maintain hip joint function and provide antibiotic elution simultaneously before re-implantation. However, antibiotic cement spacer is mechanically weak and breaks if overloaded. Therefore, we designed a cement mould with metallic endoskeleton with the aim of creating a stronger, inexpensive, antibiotic-impregnated spacer resembling a unipolar arthroplasty. We report two cases of severe hip joint infection after implant fixation (bipolar hemiarthroplasty, screw fixation neck of femur). Both patients had undergone first stage surgery of debridement and articulating antibiotic cement insertion using our design. Although the second stage surgery was planned for these patients, both patients delayed the operation in view of good functional status after a year walking with the antibiotic cement spacer. These cases showed that the mechanical property of the new antibiotic cement spacer was promising but further mechanical studies upon this new endoskeleton design are required.

Spacers in the treatment of hip joint infections: numerical analysis of their durability

Hip spacers are temporary implants having a geometry similar to the femoral component of a hip prosthesis, and they are manufactured with antibiotic-impregnated bone cement. The use of spacers in two stage revisions is the most effective treatment to eradicate infections and to avoid limb shortening. The most frequent complication associated with spacers is fatigue failure, for which doctors recommend patients to stay at rest. In this work, several spacer designs are analyzed in order to determine the feasibility of doing activities like walking, standing up or sitting down while performing the antibiotics treatment. Designs combine both different neck diameters and the presence/absence of an internal, stainless steel reinforcement. By means of computational simulations based on the finite element method, stress fields are calculated for various hip spacer designs under several load and fixing conditions. For this purpose, a 3D model of human femur is generated by processing tomographic images with segmentation techniques and inverse engineering. The results allow us to estimate the life expectancy of each design, by considering the fatigue behavior of the bone cement. Only the introduction of a reinforcement with a proper diameter into the bone cement matrix could assure the integrity of the spacer along the treatment period.

Hüftgelenkinfektionen – Ergebnisse einer Umfrage unter 28 orthopädischen Universitätskliniken

Despite numerous prophylactic measures infections still remain a hazardous complication in orthopedic surgery. A questionnaire about hip joint infections was sent to all university orthopedic departments in Germany and Austria. The questionnaire included 33 questions with respect to demographic data, causative organisms, diagnostic measures, treatment options for early and late infections, antibiotic therapy and prosthesis reimplantation. The participation rate was 70%. The most frequent primary surgical indication was primary total hip replacement and Staphylococcus aureus and S. epidermidis were the most common pathogens identified. All departments performed a joint aspiration for diagnosis confirmation but for other diagnostic measures a great discrepancy could be observed. In the treatment of early infections removable components were always exchanged, whereas a local antibiotic therapy was not always employed. With regard to late infections a two-stage protocol was more frequently used than a one-stage treatment, whereby the implantation of a cement spacer was more commonly performed than a resection arthroplasty. The time between stages varied between 6 and 12weeks and systemic antibiotics were administered for a mean time of 6 weeks. For prosthesis reimplantion cementless components were mostly used but no clear tendency could be determined for systemic antibiotic therapy. Treatment of hip joint infections among German and Austrian university orthopedic departments is only partly carried out in a similar manner.

Complications after spacer implantation in the treatment of hip joint infections

The aim of this retrospective study was to identify and evaluate complications after hip spacer implantation other than reinfection and/or infection persistence. Between 1999 and 2008, 88 hip spacer implantations in 82 patients have been performed. There were 43 male and 39 female patients at a mean age of 70 [43-89] years. The mean spacer implantation time was 90 [14-1460] days. The mean follow-up was 54 [7-96] months. The most common identified organisms were S. aureus and S. epidermidis. In most cases, the spacers were impregnated with 1 g gentamicin and 4 g vancomycin/80 g bone cement. The overall complication rate was 58.5% (48/82 cases). A spacer dislocation occurred in 15 cases (17%). Spacer fractures could be noticed in 9 cases (10.2%). Femoral fractures occurred in 12 cases (13.6%). After prosthesis reimplantation, 16 patients suffered from a prosthesis dislocation (23%). 2 patients (2.4%) showed allergic reactions against the intravenous antibiotic therapy. An acute renal failure occurred in 5 cases (6%). No cases of hepatic failure or ototoxicity could be observed in our collective. General complications (consisting mostly of draining sinus, pneumonia, cardiopulmonary decompensation, lower urinary tract infections) occurred in 38 patients (46.3%). Despite the retrospective study design and the limited possibility of interpreting these findings and their causes, this rate indicates that patients suffering from late hip joint infections and being treated with a two-stage protocol are prone to having complications. Orthopaedic surgeons should be aware of these complications and their treatment options and focus on the early diagnosis for prevention of further complications. Between stages, an interdisciplinary cooperation with other facilities (internal medicine, microbiologists) should be aimed for patients with several comorbidities for optimizing their general medical condition.

Mechanical complications and reconstruction strategies at the site of hip spacer implantation

Over the past two decades antibiotic-impregnated hip spacers have become a popular procedure in the treatment of hip joint infections. Besides infection persistence and/or reinfection, major complications after hip spacer implantation include spacer fracture, -dislocation, and bone fracture. Moreover, in cases with extensive loss of femoral and/or acetabular bone alternative reconstructive techniques should be used for a stable spacer fixation and prevention of fractures or dislocations. The present article reviews the different types of spacer fractures and dislocations and offers some suggestions about reconstructive techniques for management of extensive loss of femoral and/or acetabular bone at the site of hip spacer implantation.

Two-stage procedure in the treatment of late chronic hip infections - spacer implantation

Infection after total hip arthroplasties (THA) is a devastating complication with significant consequences for both the patients and the healthcare systems. In recent times, a two stage procedure using antibiotic-impregnated interim spacers has become the most popular treatment for late chronic hip joint infections after THA with success rates over 90%. In this review, we discuss the different types of spacers used in the treatment of chronically infected THA and conclude that hip spacers are effective in the treatment of hip joint infections.

Antibiotic-impregnated PMMA hip spacers: Current status

The infection rate after primary hip arthroplasty lies at 1–2%. In the past few years, a two-stage protocol with the implantation of an antibiotic-loaded spacer has become a popular procedure in the treatment of infected hip joint arthroplasties. In this review, we pay special attention to the elution characteristics of the spacers, their mechanical stability and the clinical response. We conclude that hip spacers are an effective method in the treatment of hip joint infections, with success rates of over 90%.