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What happens when someone gets an infection in a hip replacement?

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An update on the treatment of post-operative infection following hip replacement was recently published that may have some useful information. There are some new developments and advances in this area. One question being investigated is: since there are so many different ways to approach the problem: which treatment gives the best results?

Treatment for this problem is usually surgery including one (or more) of the following procedures: 1) irrigation and debridement, 2) one-stage exchange, 3) two-stage exchange, and 4) resection arthroplasty. Here's a brief summary about the role and results for each one.

With surgical irrigation and debridement the surgeon uses a saline solution to irrigate or wash away as much of the infection as possible. Then any infectious or dead tissue is removed (debrided). The failure rate for this type of treatment is pretty high, so this treatment method is rarely used by itself.

Instead, the one- or two-stage procedures are combined with irrigation and debridement. Once the surgeon has cleared out the infection, then the implant can be removed, antibiotic treatment applied, and the implant replaced. In a one-stage procedure, this is accomplished in one surgery. The best patient for a one-stage exchange is the person with an acute infection (early after the first surgery to put the implant in). In these cases, there hasn't been enough time for the implant to form bone around it, locking it in place.

Later infections or chronic infections (infections that have not responded to treatment and are still present months after the first surgery) are being treated with a two-stage procedure. In such cases, irrigation and debridement are done, then a portion of the implant is removed. The surgeon leaves behind the cemented area. This approach helps reduce how much bone has to be removed.

In the two-stage procedure, a special spacer is inserted into the area where the top of the implant has been removed. The spacer keeps the femur (thigh bone) from sliding up into the acetabulum (hip socket). The spacer is covered in an antibiotic. Later (when the infection is cleared up), the spacer is removed, the area is irrigated and debrided, and a new implant is put in place once again.

For all patients regardless of procedure approach, intravenous antibiotics are an essential part of the treatment. Infection after hip replacement can be a challenging problem to treat -- especially if it's not caught early and becomes chronic. The hope is that with newer techniques, post-operative joint infections of this type will respond faster and better with improved outcomes.

Reference: H. John Cooper, MD, and Craig J. Della Valle. Management of Infection After Total Hip Arthroplasty. In Current Orthopaedic Practice. November/December 2012. Vol. 23. No. 6. Pp. 543-548.

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