Excision arthroplasty with delayed wound closure for the infected total hip replacement.

Methods of management of infections in total hip replacement vary from the use of antibiotics with reimplantation to a complete removal of the prosthetic unit. This is a series of 10 consecutive patients having documented sepsis following total hip replacement characterized by gram-negative organisms which was managed with the method of excision (Girdlestone) arthroplasty with delayed wound closure. Parenteral antibiotics were used while the wound remained open. Once wound healing had been accomplished, the patients were placed on appropriate oral antibiotics and continued on same for approximately 6 months. The duration of follow-up was 3-5 years. All patients have continued to remain free of clinical sepsis. One patient has chronic pain. All patients are fully ambulatory and are fully satisfied with their functional capacities. Recognizing a serious infection following total hip replacement, especially characterized by the presence of gram-negative organisms, requires drastic treatment methods. Excision arthroplasty with delayed wound closure is a reasonable alternative, especially in view of the functional results obtained.