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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 1, 44-51.
doi: 10.1302/0301-620X.91B1.20930  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Is prolonged systemic antibiotic treatment essential in two-stage revision hip replacement for chronic Gram-positive infection?

J. P. Whittaker, FRCS(Trauma & Orth), Adult Reconstruction Fellow1; R. E. Warren, FRCSPath, Consultant Microbiologist2; R. S. Jones, FRCS(Trauma & Orth), Consultant Orthopaedic Surgeon1; and P. A. Gregson, FRCS(Trauma & Orth), Consultant Orthopaedic Surgeon1

1 Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry SY10 7AG, UK.
2 Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, Shropshire SY3 8XQ, UK.

Correspondence should be sent to Mr J. P. Whittaker; e-mail: jpwhittaker1{at}gmail.com

When using a staged approach to eradicate chronic infection after total hip replacement, systemic delivery of antibiotics after the first stage is often employed for an extended period of typically six weeks together with the use of an in situ antibiotic-eluting polymethylmethacrylate interval spacer. We report our multi-surgeon experience of 43 consecutive patients (44 hips) who received systemic vancomycin for two weeks in combination with a vancomycin- and gentamicin-eluting spacer system in the course of a two-stage revision procedure for deep infection with a median follow-up of 49 months (25 to 83).

The antibiotic-eluting articulating spacers fractured in six hips (13.9%) and dislocated in five patients (11.6%). Successful elimination of the infecting organisms occurred in 38 (92.7%) of 41 hips with three patients developing superinfection with a new organism.

We conclude that prolonged systemic antibiotic therapy may not be essential in the two-stage treatment of a total hip replacement for Gram-positive infection, provided that a high concentration of antibiotics is delivered locally using an antibiotic-eluting system.




eLetters:

Read all eLetters

Prolonged systemic antibiotics in revision hip surgery
Samer S Morgan, et al.
J Bone Joint Surg Br Online, 5 Feb 2009 [Full text]
Prolonged systemic antibiotics in revision hip surgery
Ian Stockley, et al.
J Bone Joint Surg Br Online, 13 Feb 2009 [Full text]

(c) British Editorial Society of Bone and Joint Surgery All Rights Reserved
Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General