Infection following total hip replacement in a general hospital without special orthopaedic facilities

Infection following total hip replacement is a serious complication for it is frequently impossible to resolve without removal of the prosthesis. We have reviewed 321 total hip replacements undertaken in a general hospital without special orthopaedic theatres. There were 17 deep infections, nine early and eight late. Athough the diagnosis of early infection is usually not difficult, the differentiation between late infections, mechanical failure and metal sensitivity may be a problem. This paper discusses the use of ESR, radiographs, isolation of pathogenic organisms and bone scanning in reaching the diagnosis of infection of the hip. There is possibly a parallel between prosthetic infection and subacute bacterial endocarditis. Therefore all intercurrent infections and episodes of trauma should be given an adequate course of a broad spectrum antibiotic. Sterile air and laminar flow systems are discussed and compared with prophylactic antibiotics, both systemic and local, in attempting to reduce the overall rate of infection following total replacement of the hip.