[Local antisepsis in infected total hip endoprosthesis]

Between 1991 and 1993, 34 infected total hip prostheses were treated with the topical antiseptic hexamethylenbiguanide (Lavasept) in addition to thorough débridement of infected and necrotic tissue and systemic antibiotic administration. In 4 cases (group 1) a contaminated hematoma was treated within the first 3 weeks after joint replacement. Soft tissue revision without removal of the prosthesis was performed in 6 cases (group 2). In 18 cases (group 3) a one-stage exchange of the infected prosthesis was done. In 6 cases (group 4), local and general conditions were so poor that the prosthesis was removed without replacement. The success rate was 100% in group 1, 20% in group 2, and 77% in group 3. In group 4, 1 patient died of respiratory problems 12 days after surgery while in 2 patients the infection healed uneventfully and in 1 patient healing was achieved after a second revision. An 81-year-old patient in poor general condition had an impressive improvement of his severe infection, although very minor drainage continued. Hexamethylenbiguanide has proven to be a useful supplement to thorough surgical revision. However, longer follow-up data are required.