Persistent infection associated with residual cement after resection arthroplasty of the hip

The danger of residual bone cement after resection of infected prosthetic components is controversial.

We analyzed 10 patients with infected total hip prosthesis who had been treated previously with resection arthroplasty and antibiotics and who had persistent infection with residual cement. In 9 patients, surgical debridement with resection of all the PMMA was performed, and adequate intravenous antibiotics were administered. 1 patient refused surgical treatment, but accepted antibiotics.

At an average of 4 (1-18) years of follow-up, 8 patients had no signs or symptoms of recurrent infection. 1 severely immunodeficient patient died 2 years after the removal of residual cement, for reasons other than his hip. The patient who refused surgical treatment continues to have an active sinus 4 years after first consultation.

Residual cement may be responsible for chronic infection. At resection arthroplasty, as part of the treatment of an infected hip arthroplasty, all devitalized or foreign material must be removed.