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Do resistant organisms affect success of two-stage reimplantation for prosthetic hip infections?

Murray, Trevor G.; Cochran, Jason; Klika, Alison K.; Krebs, Viktor E.; Barsoum, Wael K.

doi: 10.1097/BCO.0b013e31820f7730

Background Infected total hip arthroplasty (THA) generates substantial personal, social, and economic burden. Revision procedures for infection are associated with longer operative times, more blood loss, and more complications compared with revisions for aseptic loosening or primary THA.

Methods We retrospectively evaluated 44 patients who had THA and underwent a two-stage revision for prosthetic hip infection with methicillin-resistant or vancomycin-resistant organisms between 1995 and 2005. The minimum follow-up was 24 months (average, 45.2 months; range, 24–130 months). Treatment was considered a failure if a two-stage procedure failed to control the infection and required repeat surgery.

Results A two-stage revision procedure with culture-specific antibiotics controlled the infection in 29 of the 44 patients (66%). Of the remaining 15 patients, 10 (23%) had a reinfection, and five (11%) had a relapse with the same organism.

Conclusions Infection was controlled in two-thirds of the patients with resistant infections using a two-stage approach. These data highlight the importance of considering the virulence of infecting organisms when treating prosthetic hip infections. The likelihood of controlling the infection with a single two-stage procedure is inferior to that reported in the literature for susceptible organisms.

Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio

Financial Disclosure: Dr Baroum receives research support from Stryker Othopaedics, Zimmer, Salient Surgical Technologies, Cool Systems, and Orthovita. He is a consultant for Stryker Orthopaedics, Wright Medical, and Shukla Medical. He has received royalties from Stryker Orthopaedics, Exatech, Wright Medical, and Shukla Medical and stock options from Ostimed.

Correspondence to Alison K. Klika, MS, Department of Orthopaedic Surgery, A41, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195 Tel: +216 444 4954; fax: +216 445 6255; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.