Periprosthetic infection: are current treatment strategies adequate?

Two-staged resection arthroplasty with delayed reimplantation is currently the method of choice for treatment of an infected total hip arthroplasty. There is paucity of data regarding the risk factors for reinfection after reimplantation. The objective of this study was to determine the efficacy of two-stage resection arthroplasty for infected THA and to identify risk factors for reinfection. The outcome of this procedure was evaluated in 54 consecutive patients at our institution from January 1999 to August 2005. The mean follow-up time for patients who were successfully treated was 32 months (range: 24 to 76 months). Infection with methicillin-resistant organisms occurred in 33 patients (61%). Recurrent infection was diagnosed in 14 patients (26%) after the second stage reimplantation procedure at an average of 10.6 months. An elevated ASA, which is an indicator of advanced comorbid health status, and infection with methicillin-resistant organisms were risk factors for treatment failure. An additional 8% of the cohort developed early mechanical failure at a mean of 13.8 months. The increase in the number of resistant organisms and the rise in the number of patients with comorbid conditions have compromised the efficacy of two-stage exchange arthroplasty. Hence novel techniques for the treatment of periprosthetic infection are desperately needed.