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Updated: Jun 6, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Infection in total hip replacement: meta-analysis
Surendra Senthi1, Jacob T Munro, Rocco P Pitto
1Department of Orthopaedic Surgery, Middlemore Hospital, South Auckland Clinical School, University of Auckland, Private Bag, 93311, Auckland, New Zealand.
Abstract:
While total hip arthroplasty has progressed to become one of the most successful surgical procedures ever developed, infection remains a serious complication. We have conducted a review of the literature pertaining to management of deep infection in total hip arthroplasty, specifically focusing on clinically relevant articles published in the last five years. A search was conducted using MEDLINE and PubMed, as well as a review of the Cochrane database, using the terms "total hip arthroplasty", "total hip replacement" and "infection". References for all selected articles were cross-checked. While the so-called two-stage revision is generally considered to be the gold standard for management, numerous studies now report outcomes for implant retention and reassessing one-stage revision strategies. There are encouraging reports for complex reconstruction options in patients with associated severe bone stock loss. The duration of antibiotic therapy remains controversial. There is concern about increasing bacterial resistance especially with the widespread use of vancomycin and ertapenem (carbapenem).
Insights
Managing deep infections after total hip arthroplasty (THA) is challenging. Recent literature reviews explore implant retention and one-stage revision strategies, alongside concerns about antibiotic resistance.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Deep infection is a significant complication following total hip arthroplasty (THA), a highly successful surgical procedure.
- Managing these infections is complex and requires careful consideration of treatment strategies.
- Recent advancements and evolving challenges necessitate a review of current management practices.
Purpose of the Study:
- To review the latest literature on managing deep infections in total hip arthroplasty.
- To focus on clinically relevant articles published within the last five years.
- To synthesize current evidence on revision strategies and antibiotic use.
Main Methods:
- Comprehensive literature search using MEDLINE, PubMed, and Cochrane database.
- Inclusion of clinically relevant articles published in the last five years.
- Cross-checking of references from selected articles.
Main Results:
- Two-stage revision remains a gold standard, but implant retention and one-stage revision strategies show promising outcomes.
- Complex reconstruction options are effective for patients with severe bone stock loss.
- Controversy exists regarding optimal antibiotic therapy duration, with concerns about rising bacterial resistance.
Conclusions:
- While two-stage revision is standard, emerging evidence supports alternative strategies like implant retention and one-stage revisions.
- Effective management of bone stock loss is crucial in complex cases.
- Careful antibiotic selection and stewardship are vital due to increasing bacterial resistance.
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