Treatment of the infected total hip arthroplasty

Based on our present experience, excisional arthroplasty is the most reliable option. Infections caused by organisms of significant virulence are best treated with excisional arthroplasty or Girdlestone resection followed by delayed reinsertion after adequate antibiotic treatment has controlled the sepsis, as determined by clinical and laboratory criteria. In patients with infections caused by organisms of relatively low virulence, for example, Staphylococcus epidermidis or anaerobic diphtheroids, the surgeon should seriously consider either incision and drainage, debridement, and local and systemic antibiotics if there is no component loosening, or direct exchange (removing both components and reinserting them with antibiotic cement) if there is loosening of one or both components. However, if incision and debridement or direct exchange fails, then excisional arthroplasty as a definitive procedure or as a first stage of a removal and reinsertion should be carried out. While we have not been successful in treating even early infections caused by Staphylococcus aureus with incision, drainage, and antibiotics, the morbidity associated with this procedure is extremely low compared with that of the other procedures; therefore it seems reasonable to use this modality as an emergency treatment for acute infections, with the full realization that it probably will not succeed as the definitive procedure, and the surgeon should prepare for early, more definitive surgical intervention.