Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol

Forty-four patients (46 hips) with infected total hip arthroplasties were evaluated. They were entered into a protocol that included resection arthroplasty, six weeks of intravenous antibiotics which obtained a minimum postpeak serum bactericidal titer of 1:8, and possible reimplantation. Thirty-two of 46 hips (70%) were reimplanted. At an average of 40 months (range, 24-74 months) after reimplantation, infection recurred in three hips (9%). In two of the three recurrent infections, 1:8 bactericidal titers were not attained. Both of these hips were infected with gram-negative organisms. Minimum postpeak serum bactericidal titers of 1:8 were attained in 28 of 32 hips that were reimplanted, and only one of these hips (4%) had a recurrent infection (p = 0.035). The presence of retained cement after resection arthroplasty (ten hips) was not associated with recurrent infection. Fourteen hips (12 patients were not reimplanted as a result of a combination of factors, including inadequate bone stock, poor soft-tissue quality, and antibiotic resistance of the infecting organism. The treatment of an infected total hip arthroplasty with resection arthroplasty, six weeks of intravenous antibiotics that attains a minimum postpeak serum bactericidal titer of 1:8, and reimplantation can be an effective and safe treatment.