Two-stage reconstruction of a total hip arthroplasty because of infection.

From 1969 to 1985, eighty-one patients (eighty-two hips) who had an infection after a previous total hip arthroplasty were treated with a resection arthroplasty, followed by delayed reconstruction in the form of a repeat total hip arthroplasty. For all of the reconstructions, the femoral and acetabular components were fixed to bone with cement that did not contain antibiotics. An average of 5.5 years (range, 2.0 to 13.6 years) after reimplantation, infection had recurred in eleven hips (13 per cent). The presence of retained cement at the time of the resection arthroplasty appeared to be associated with recurrent sepsis, as three of seven patients who had retained cement had a recurrent infection, compared with only eight (11 per cent) of seventy-five patients from whom the cement had been completely removed (p less than 0.01). The twenty-six patients (twenty-six hips) who had the reimplantation less than one year after the resection arthroplasty had seven recurrent infections (27 per cent), while the fifty-six patients who had reimplantation more than one year after the resection arthroplasty had only four recurrences (7 per cent) (p less than 0.001). Three of the seven patients in whom the infection was caused by gram-negative bacilli and group-D streptococcal organisms (which are considered highly virulent) and who received systemic antimicrobial therapy for less than twenty-eight days had a recurrence. In contrast, only one of the thirteen patients in whom the infection was caused by a virulent organism and who were treated for longer than twenty-eight days had a recurrence (p = 0.055). The two-stage reconstruction is an effective, safe technique even when the infection is caused by a virulent organism.