Fares S. Haddad
DALLAS — Simple lavage and irrigation and debridement are inappropriate for managing a patient whose cementless total hip arthroplasty is acutely infected. This situation calls for a rapid return to the OR for one-stage revision surgery and aggressive debridement and treatment of the infection, according to a presenter at the American Association of Hip and Knee Surgeons Annual Meeting.
This treatment is associated with a high degree of success, according to Fares S. Haddad, FRCS.
Coagulase negative staphylococcus is the usual infecting organism, he noted. For revision antibiotics, Haddad said he uses vancomycin, gentamicin and “increasingly an antifungal, because we’re seeing more of the fungal infections.”
Haddad said the appropriate treatment is not irrigation and debridement, but rather open arthroplasty.
“The key message here is if you have early onset infection, it is easy to remove the implant, so you may as well take advantage. They will come out,” he said, noting that at the time of the reconstruction, once the infection is dealt with, the same size implant can be used as the original. Usually, a 3-month course of antibiotics after these procedures is sufficient for most patients, according to Haddad.
In discussing his results in 39 patients who underwent one-stage revision of primary or revision cementless THA for acute infection from 2004 to 2014, Haddad said all the patients were culture positive.
“In this setting, we have only seen four re-infections,” he said.
Infection control was 90% at the 5-year follow-up in these cases, according to Haddad, who is a member of the Orthopaedics Today Europe Editorial Board.
He noted the technique is also effective for patients with polished cemented THA stems or a cementless total knee arthroplasty. – by Susan M. Rapp
Haddad FS. Cementless implant within 4 weeks of surgery: What, when and how? Presented at: American Hip and Knee Surgeons Annual Meeting; Nov. 7-10, 2019; Dallas.
Disclosure: Haddad reports he receives IP royalties from Corin and MatOrtho, and is a paid consultant for and receives IP royalties and research support Smith & Nephew and Stryker.