TREATMENT OF INFECTION AFTER PRIMARY TOTAL HIP ARTHROPLASTY IN A UNIVERSITY HOSPITAL

Aim To see what surgical strategy was used in treating infected total hip arthroplasties (THA), relative to bacterial findings, level of inflammation, length of antibiotic treatment (AB) and re-revisions. Further, to assess the results of treatment after three months and one year. Method We used our national arthroplasty register (NAR) to identify THA revised for deep infection from 2004–2015 reported from our hospital. We identified the strategy of revision, i.e. one-stage exchange (one-stage), two-stage exchange (two-stage), debridement and implant retention (DAIR), or Girdlestone, and reported re-revisions for infection. We defined cure as no AB, no need for further surgery and joint with prosthesis (not Girdlestone). From the hospitals’ medical records we retrieved bacterial findings from the revisions, level of C-reactive protein (CRP), type of antibiotics given, duration of antibiotic therapy and clinical data regarding the patients. The information reported to the NAR was also validated. Results We found 69 patients reported to the NAR for first revision for infection after primary THA. Most patients were treated with DAIR or two-stage. DAIR was used for infections with short period of symptoms, two-stage for longer lasting infections. In the DAIR-group, three patients needed another DAIR. Six patients were converted to two-stage exchange. Four patients had Girdlestone as strategy from primary revision due to co-morbidity. No patients treated with other strategies ended up with Girdlestone. 60 % and 90 % were cured for the infection after three and twelve months respectively. Conclusions Infected THAs were treated according to duration of symptoms. After one year about 90 % were cured.