Acute and subacute deep infection after uncemented total hip replacement using antibacterial prophylaxis

Nine hundred thirty-two uncemented total hip replacement arthroplasties were studied. Seven hundred nineteen of these were primary operations with or without bone autograft. Two hundred thirteen were revisions with bone autograft and/or allograft. All were done by a single surgeon in a single operating theater. Prophylaxis included perioperative and postoperative antibiotics using either cefazolin or vancomycin, the use of a laminar flow room, and the use of total body exhaust systems. Aspiration of the hip with culture of the derived joint fluid was carried out preparatory to revision surgery. In each instance, the culture was negative. One acute infection and three subacute infections occurred three months and five months respectively after the index operation. One infection occurred seven months following complex revision surgery with bone allografting and autografting. The overall incidence of deep sepsis (four of 932 total cases) was 0.43%. The incidence of deep sepsis in the primary cases alone (three of 719) was 0.42%. In the revision series, the incidence of deep sepsis (one of 213) was 0.47%. No attempt was made to quantify the incidence of late sepsis. The incidence of acute and subacute postoperative deep sepsis after uncemented hip replacement, including revision surgery with major bone grafting, was comparable to other previously reported results on cemented hips.