The incidence of sepsis after total hip replacement arthroplasty

The incidence of surgically acquired infection during the first 2 years after total hip arthroplasty has decreased more than 10-fold since the introduction of the procedure. Advances in surgical procedures, sterile technique, and antibiotic prophylaxis have contributed to the current incidence of less than 0.5% in most major centers. At the present time, the majority of cases are not related to intra-operative contamination, but to late seeding of the joint from bacterial sources elsewhere in the body. Unfortunately, the overall infection rate (when late sepsis is included) remains at over 1%, and will likely increase as the life expectancy of implants is increased and patients are followed up longer. Given that late sepsis is now the most common type of infection involving total hip replacements, attempts to reduce the infection rate must be directed toward this patient population. Methods must include patient education to prevent sepsis, as well as to identify potentially dangerous infections early so they can be treated expeditiously. The development of a sound basis for antibiotic prophylaxis in cooperation with our medical and dental colleagues in this regard will be welcome. The prompt treatment of infections before they can spread to the prosthetic joint is essential for the continued well-being of the total hip arthroplasty patient.