Late infection after total hip replacement

Area of Science:

• Orthopedic surgery
• Infectious disease
• Biomaterials science

Background:

• Total hip replacement (THR) using McKee-Farrar prostheses is a common procedure.
• Deep prosthetic joint infections (PJIs) are a serious complication following THR.
• The timing and origin of PJIs can be variable and challenging to diagnose.

Observation:

• A case series of four patients experiencing deep hip infections after McKee-Farrar THR is presented.
• Infections manifested an average of 3.5 years post-implantation.
• Multiple prosthetic components were affected across the six hips.

Findings:

• Strong evidence linked the deep hip infections to a distant infectious focus in all reported cases.
• The distant source suggests hematogenous seeding as a potential mechanism.
• No intraoperative contamination was implied as the primary cause.

Implications:

• This highlights the importance of considering non-surgical site origins for late-onset PJIs.
• Diagnostic protocols for late PJIs should include screening for distant infections.
• Understanding infection pathways can inform prevention and treatment strategies for prosthetic joint infections.