Long-term suppression of infection in total joint arthroplasty

Clin Orthop Relat Res. 2003 Sep:(414):55-60. doi: 10.1097/01.blo.0000087321.60612.cf.

Abstract

Optimal treatment for a chronic infected prosthesis is the removal of infected and necrotic tissue and all the components of the prosthesis with staged revision in conjunction with systemic antibiotics. If this is not possible because of the poor general condition of the patient, because of unacceptable functional results secondary to removal of the prosthesis, or because the patient refuses surgery in an attempt to salvage the infected prosthesis, a reasonable alternative is long-term oral suppressive antibiotic therapy for maintenance of a functioning prosthesis. Prompt recognition with rapid debridement and initiation of antibiotic therapy seems crucial. Our study confirms a favorable outcome of maintenance of functioning prostheses in 86.2% of patients after a mean followup of 5 years. All patients had initial debridement with 4 to 6 weeks of systemic antibiotic therapy. Advanced age did not seem to predict poor outcome. Joint location, duration of symptoms, and the time of onset of infection did not predict success or failure. The overall success rate for Staphylococcus aureus prosthetic joint infection was 69% after a mean followup of 5 years. The ideal regimen and optimal duration of oral suppressive therapy for a favorable outcome is not well-established and needs additional data with prospective multicenter studies.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Arthroplasty, Replacement, Hip*
  • Debridement
  • Female
  • Hip Prosthesis / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Prosthesis-Related Infections / drug therapy*
  • Prosthesis-Related Infections / microbiology
  • Prosthesis-Related Infections / prevention & control
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / prevention & control
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents