Management of infected knee and hip prostheses

Infection following total hip or total knee arthroplasty can be devastating. It can result in instability of the hip or knee, diminished function, amputation, or death. Fulminant infection is unusual. Chronic low-grade infection is more commonly seen clinically. Differentiation of pain in a total hip or total knee replacement from loosening or infection may be difficult. Aspiration of the hip or knee for three aerobic and anaerobic cultures and sensitivities is the most reliable method of diagnosing infection. In the hip joint, aspiration should be performed under radiographic control. Treatment of the infected total hip or total knee by antibiotics alone is ineffective. Debridement of the hip or knee joint with retention of the prosthesis and intravenous antibiotics is successful in 18% to 40% of cases. Resection arthroplasty of the hip or knee usually results in eradication of the infection but leaves a painful, unstable, and shortened extremity and diminished ability to ambulate. Arthrodesis of the knee usually clears the infection but imposes the disability of a stiff knee. Two-stage reimplantation of the hip or knee is the most successful means of treating the infected total hip or knee replacement. In the knee, the success rate with two-stage reimplantation is 80% to 97%. In the hip joint, the success rate of two-stage reimplantation is 83% to 87%. Recently, debridement of the hip or knee with retention of the prosthesis and the local installation of antibiotics for a prolonged period has been used in cases of acute infection of less than 3 months' duration without evidence of implant loosening.(ABSTRACT TRUNCATED AT 250 WORDS)