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World J Orthop. Jul 18, 2014; 5(3): 218-224
Published online Jul 18, 2014. doi: 10.5312/wjo.v5.i3.218
Can periprosthetic hip joint infections be successfully managed by debridement and prosthesis retention?
Konstantinos Anagnostakos, Cornelia Schmitt
Konstantinos Anagnostakos, Cornelia Schmitt, Klinik für Orthopädie und orthopädische Chirurgie, Universitätsklinikum des Saarlandes, D-66421 Homburg/Saar, Germany
Author contributions: All authors contributed to this work.
Correspondence to: Konstantinos Anagnostakos, PD, Klinik für Orthopädie und orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstr. 1, D-66421 Homburg/Saar, Germany. k.anagnostakos@web.de
Telephone: +49-6841-1624520 Fax: +49-6841-1624516
Received: November 27, 2013
Revised: March 14, 2014
Accepted: April 11, 2014
Published online: July 18, 2014
Abstract

To evaluate the current literature about how successfully periprosthetic hip joint infections can be managed by debridement and prosthesis retention. A literature search was performed through PubMed until September 2013. Search terms were “DAIR (debridement, antibiotics, irrigation, and retention)” alone and in combination with “hip” as well as “hip infection + prosthesis retention”. A total of 11 studies reporting on 292 cases could be identified. Five different treatment modalities have been described with varying success rates (debridement-21% infection eradication rate; debridement + lavage-75% infection eradication rate; debridement, lavage, with change of modular prosthesis components-70.4% infection eradication rate; debridement, lavage, change of modular prosthesis components + vacuum-assisted closure-92.8% infection eradication rate; acetabular cup removal + spacer head onto retained stem-89.6% infection eradication rate). With regard to the postoperative antibiotic therapy, no general consensus could be drawn from the available data. Debridement, antibiotic therapy, irrigation, and prosthesis retention is an acceptable solution in the management of early and acute hematogenous periprosthetic hip joint infections. The current literature does not allow for generalization of conclusions with regard to the best treatment modality. A large, multi-center study is required for identification of the optimal treatment of these infections.

Keywords: Hip joint infection, Prosthesis retention, Debridement, Hip revision, Antibiotic therapy, Irrigation

Core tip: Infections after total hip arthroplasty are a hazardous complication. Prosthesis retention is though to be possible in case of early infections, whereas several treatment modalities might be applied. The ideal treatment procedure is still unknown. The present work reviews the current literature about how successfully periprosthetic hip joint can be managed by debridement and prosthesis retentiond and treid to shed some light onto this difficult topic.