Treatment of infected total hip arthroplasty

Periprosthetic infection of the hip is a rare but serious complication. One can differentiate between early (within four weeks after the implantation) and late periprosthetic infections. In early infections radical debridement, lavage and the change of the inlay and head is the treatment of choice. In late infections all foreign material has to be removed. Many concepts of treatment have been devised. A two-stage revision with a temporary antibiotic-impregnated cement spacer and a cemented prosthesis appears to be the most preferred procedure although, in recent times, there seems to be a trend towards cementless implants and a shorter period of antibiotic treatment. Because of the differences in procedure, not only between studies but also within studies, it cannot be decided which period of parenteral antibiotic treatment and which spacer period is the most suitable. The fact that comparable rates of success can be achieved with different treatment regimens emphasises the importance of surgical removal of all foreign materials and the radical debridement of all infected and ischaemic tissues and the contribution of these crucial procedures to the successful treatment of late periprosthetic infections