Principles for the diagnosis of infections following total hip arthroplasty

Based on authorial material consisting of 19 patients operated in the period 1993-2000 for infections following total hip replacements, and on information from the literature, the authors discuss the suitability of various diagnostic methods. It is particularly important to diagnose infections with a slow course, without the classic clinical signs. The diagnostic criteria accepted by the Disease Control Center in Atlanta are presented, along with the radiological symptoms of latent infections and scintigraphic methods of varying sensitivity and specificity to regards to hip endoprosthesis infections. The article presents the typical changes in the value of erythrocyte precipitation and CRP concentration during the first year following a non-complicated hip arthroplasty, which has a significant impact on the interpretation of results when there is a suspicion of early infection. The decisive test for the diagnosis of a slow infection in a joint with loosened endoprosthesis with obvious clinical signs of infection is peri-operative examination of frozen scraps of the joint capsule for the presence of infiltrations of neutrophil leukocytes.