Outcomes of One-Stage Total Hip Arthroplasty with Postoperative Intra-Articular Antibiotic Infusion for Chronic Infection after Periarticular Internal Fixation Failure.

Abstract

Introduction: Chronic infection following periarticular internal fixation is challenging, with no standard treatment protocol. This study evaluated the results of one-stage total hip arthroplasty (THA) using intra-articular (IA) antibiotic infusions to treat this condition.

Methods: A retrospective analysis (2013 to 2023) included 26 patients who had chronic infection following periarticular internal fixation undergoing one-stage THA with IA antibiotic infusions. Initial internal fixation involved six cases of plates and screws, 11 cannulated compression screws, and nine intramedullary nails. In the microbiological cultures, 13 cases (50%) were positive, consisting of five cases of methicillin-resistant Staphylococcus epidermidis (MRSE), one case of methicillin-resistant Staphylococcus hominis (MRSH), two cases of Staphylococcus aureus, one case of Corynebacterium striatum, two cases of Escherichia coli, one case of Enterobacter cloacae, and one case of a mixed infection of Enterococcus faecalis and MRSE; and 13 cases (50%) were negative cultures. After removal of all index internal fixation and thorough debridement and irrigation, IA antibiotic infusions were administered for an average of 10 days (range, four to 19), guided by culture results. Infection recurrence and clinical outcomes were evaluated.

Results: Of the 26 patients, 25 (96.2%) remained free of periprosthetic joint infection (PJI) at a mean follow-up duration of 65.0 ± 30.2 months (range, 12 to 136). The five-year PJI-free survival cumulative rate was 96.2% (95% confidence interval [CI]: 88.8 to 100), while the five-year prosthesis survival cumulative rate was 88.5% (95% CI: 74.6 to 100). Complications included two cases of hip dislocation and one case of periprosthetic femur fracture, with two of these cases requiring further surgical revision. Additionally, two cases of deep venous thrombosis and two cases of delayed wound healing were reported. The mean Harris hip score (HHS) at the most recent follow-up was 91.0 points (range, 80.2 to 97).

Conclusion: A one-stage THA with IA antibiotic infusions demonstrated high infection control rates and favorable clinical outcomes for chronic infection following periarticular fixation. This approach offers valuable insights and therapeutic strategies for treating this complex condition.