Principles for the management of deep infections following total hip replacement

Current methods are presented for the management of deep infection of total hip replacements. The goal of treatment is to maintain the improvement of function gained by hip replacement. In cases without loosening, precise surgical debridement without removal of implants is indicated. Management in septic loosening depends on the general medical condition of the patient, the local bone stock, and the spread of infection. Satisfactory bone stock allows for reimplantation of a new prosthesis, prefably using antibiotic-loaded cement, after scrupulous removal of all potentially infected tissues and particles. The reimplantationcan be done as a one- or two-stage operation. In the two0stage procedure, antibiotic-loaded cement spacer can be used, but both two- and one-stage reimplantation have similar results as regards infection control. Definitive removal of the prosthesis is indicated in patients whose general medical condition is poor, who have no usable bone stock, or who present with a persistent Gram-negative bacterial infection. This procedure is not fully effective, however (infection brought under control in 83% of patients), although it does not cause significant negative effect for the functional status of this group of patients.