Irrigation and debridement, component retention seen as viable option for treating hip infection
In a contemporary series, investigators found irrigation, debridement and component retention for hip infection had a high rate of success, especially among patients considered McPherson systemic grade A hosts.
Daniel J. Berry, MD, and colleagues managed 90 hips with acute periprosthetic hip infection using either irrigation and debridement and retention of well-fixed implants with a modular head and liner exchange or with irrigation and debridement alone. The McPherson criteria was used to stratify patients. Researchers defined failure as the failure to eradicate infection, subsequent removal of any component for infection, unplanned second wound debridement for ongoing deep infection or the occurrence of periprosthetic joint infection-related mortality.
Results showed 17% of hips had treatment failure, with component removal secondary to recurrent infection in 10% of hips. Researchers found treatment failure occurred in 15% and 21% of hips after early postoperative infection and after acute hematogenous infection, respectively.
A treatment failure rate of 8% was found among patients categorized as McPherson host grade A vs. a rate of 16% in McPherson host grade B and 44% in McPherson host grade C. Researchers noted that most treatment failures occurred within the initial 6 weeks of treatment. Among the failures that occurred after 6 weeks of initial treatment, results showed 3% occurred among patients treated with chronic antibiotic suppression and 11% occurred in patients who were not treated with suppression.
“This paper demonstrates that when irrigation and debridement with major component retention was carried out with modern techniques for strictly defined acute deep infection after hip arthroplasty followed with intravenous antibiotics and later (in most cases) with long-term oral antibiotic suppression, the likelihood of successful component retention at 5 years or more was surprisingly high — more than 80%,” Berry told Healio.com/Orthopedics. “Patients with few comorbidities (grade A hosts) had the best results.” – by Casey Tingle
Disclosures: Bryan reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.