Revision of infected total hip arthroplasty

Extension of infection down the medulla of the femur to the supracondylar region may occur in cases of chronic infected total hip arthroplasty. Because this cannot always be identified before operation, the femur should be reamed and flushed proximally from the lateral condyle in all cases where there is suspicion of infection around the femoral component. Where infection is unequivocal and extensive, a period of irrigation and suction drainage is advisable before final total hip arthroplasty. After the prosthesis has been inserted in either one or two stages, it is wise not to rely on antibiotic cement mixtures alone but to monitor the bacterial flora and prescribe local antibiotic therapy accordingly.