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TWO-STAGE EXCHANGE ARTHROPLASTY FOR INFECTION-ARE DEPOT ANTIBIOTICS SUFFICIENT?

Department of Orthopaedic Surgery, Northern General Hospital, Sheffield Teaching Hospitals Trust, Herries Road, Sheffield, S5 7AU

Introduction: The use of prolonged courses of parenteral or oral antibiotic therapy in combination with a two-stage exchange procedure in the management of the infected total hip arthroplasty is reported by many major series.

Methods: We present a series of 114 patients, all with microbiologically proven chronic deep infection, treated with a two-stage exchange with antibiotic loaded cement and where a prolonged course of antibiotic therapy has not been used. The mean follow-up for all patients is 74months (range 2–175months) with all surviving patients having a minimum 2 year follow-up.

Results: Infection was successfully eradicated in 100 patients (88%). The infection cure rate in our series is similar to that reported elsewhere where prolonged adjuvant antibiotic therapy was used.

Discussion: Using the technique described a prolonged course of systemic antibiotics does not appear to be necessary; the high costs of antibiotic administration, both to the patient and care facility are not incurred.

Correspondence should be addressed to Mr Peter Howard, Editorial Secretary, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.