Management of infection associated with total hip arthroplasty according to a treatment algorithm

Background: An algorithm for the management of hip arthroplasty-associated infections was validated in a cohort study. Patients: 60 patients with 63 episodes of total hip arthroplasty-associated infections observed from 1985 to 2001 were included. The treatment algorithm was based on the time of manifestation, pathogenesis, and condition of implant and soft tissue. Three treatment options were proposed, namely debridement with retention, one-stage and two-stage replacement. Results: The median patients' age was 72 years, the median follow-up 28 months; 29% were early, 41% delayed, and 30% Late infections, 57% of the infections were exogenously and 43% hematogenously acquired. The overall success rate for the first treatment attempt was 83% (52/63). Patients treated according to the algorithm had a better outcome than the others (44/50=88% vs 8/13=62%, Relative risk (RR) 0.31, 95% confidence interval (CI): 0.11-0.86, p<0.03); those treated with adequate antimicrobial therapy had a better success rate (87% vs. 50%, p<0.01). Conclusion: The proposed algorithm defines a rational surgical/antibiotic treatment strategy.