Efficacy of Debridement for Early Periprosthetic Joint Infection after Hip Arthroplasty

PURPOSE In early prosthetic joint infection after hip arthroplasty, debridement with prosthesis retention may be performed for implant salvage, but the reported success rates are highly variable. Hence we reviewed the outcome of radical debridement and retention of prosthesis using established diagnostic criteria and surgical procedures in relation to significant variables including clinical characteristics, pathogenicity, and antibiotic treatment. MATERIALS AND METHODS We retrospectively reviewed 20 patients (11 men and 9 women) with early prosthetic joint infection after unilateral hip arthroplasty, treated by radical debridement with retention of prosthesis from January 2000 to May 2011. Average follow-up period was 55 months (12-178 months). The outcome was evaluated and analyzed based on recurrence of infection and clinical (Harris hip score) and radiological criteria. RESULTS Pathogens were isolated from 11 hips (methicillin-resistant Staphylococcus aureus [MRSA] in three, methicillin-resistant Staphylococcus epidermidis [MRSE] in two, methicillin-sensitive Staphylococcus aureus [MSSA] in one, Acinetobacter baumannii in two, Enterococcus faecalis in two patients, and Enterococcus, Citrobacter species in one). The mean duration of antibiotic administration was 43.5 days. Recurrence of infection was not observed in any case. Average Harris hip score was 91 points at the last follow-up. Revision surgery was not required for any reason including implant failure. Dislocation occurred in two hips after debridement and was treated conservatively. CONCLUSION Radical debridement with prosthesis retention is an effective procedure for early prosthetic joint infection after hip arthroplasty in carefully selected patients and with early diagnosis.