Intra-articular antibiotics : a direct approach to the treatment of infected cementless total hip arthroplasty.

Abstract

The use of intra-articular antibiotics in the treatment of periprosthetic joint infection (PJI) can achieve a concentration which is sufficient to eradicate a biofilm. This may mitigate the need for removal of infected but well-fixed cementless components of a total hip arthroplasty (THA). However, the use of percutaneous catheters might lead to multiresistance or persistent multiorganism infections. The aim of this study was to report the results of a series in which an intra-articular antibiotic infusion was added to a single-stage revision for infected cementless THAs. A total of 18 patients underwent 18 single-stage revision THAs which were performed for acute (n = 9) or chronic (n = 9) PJI, following a primary (n = 12) or revision (n = 6) cementless THA. After an extensive debridement, modular components were replaced, but all well-fixed components were retained. Two Hickmann catheters were introduced into the joint space, through which intra-articular antibiotics were introduced for two weeks. Intravenous antibiotics were also administered during this time, followed by oral antibiotics until three months after surgery. At a mean follow-up of 5.4 years (3.3 to 7.19), all patients had a normal ESR and white blood cell count. The CRP remained slightly elevated in three patients, although they were pain-free and showed no signs of infection. No patient developed antibiotic-related renal or systemic dysfunction postoperatively. We found that for the treatment of an infected cementless THA, retention of well-fixed components was feasible, with the addition of intra-articular antibiotics to a standard single-stage regime. None of the 18 patients had persistent infection or catheter-induced drug resistance, at a mean follow-up of 5.4 years.