News About Treating Infections After Hip Replacement

Orthopedic surgeons performing total hip replacements (known as total hip arthroplasty or THA) will be interested in this update on the treatment of post-operative infection. New developments and advances in this area deserve attention. Since there are so many different ways to approach the problem, the question is: which treatment gives the best results?

To help determine optimal strategies for managing post-operative hip infection, the authors reviewed all the current studies done in this area. They found some excellent information coming from Europe. There surgeons use a formula or algorithm to select the right procedure for each patient.

The surgical approaches to this problem include: 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.

Surgical irrigation and debridement is often used for many other problems of this type. 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. At least one study has shown that intravenous antibiotics can be given for two weeks and then the patients are switched to an oral (pill by mouth) antibiotic. Early studies show this method is effective and the infection does not return. More studies will be needed before this becomes a standard treatment method.

The authors conclude that 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. Treatment patterns are definitely changing so surgeons can expect to see more on this topic in the future.