Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Treatment of Infected Total Hip Arthroplasty

감염된 인공 고관절의 치료

  • Ko, Han-Seok (Department of Orthopaedic Surgery, Seoul Paik Hospital, College of Medicine, Inje University) ;
  • Bae, Woo-Han (Department of Orthopaedic Surgery, Seoul Paik Hospital, College of Medicine, Inje University)
  • 고한석 (인제대학교 서울백병원 정형외과학교실) ;
  • 배우한 (인제대학교 서울백병원 정형외과학교실)
  • Published : 2010.06.30
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Abstract

Deep infection after total hip arthroplasty is one of the most serious post operative complications. Treatment of infection of the hip joint can be made very difficult by poor response to antibiotic therapy. Infection rates of total hip arthroplasty have decreased due to prophylactic antibiotics, sterilization of surgical instruments, cleaner operation environments, Improvement of surgical methods and proper patient selection. Recently, post operative infection rates of primary or revision arthroplasties were reported to still be as high as 1% to 2%. Therefore, the aim of this article is to review the recent literature and to evaluate the cause, environment diagnosis and treatment of infection after total hip arthroplasty.

인공 고관절 치환술 후 발생하는 심부 감염은 술 후 발생하는 합병증 중에서 가장 심각한 것이다. 인공 고관절의 감염이 있는 경우 항생제의 치료에 반응하지 않아 염증에 대한 치료가 어려운 경우가 많다. 인공 고관절 전치환술 후에 발생하는 감염은 예방적 항생제 투여 및 수술기구 및 수술실 환경의 소독, 그리고 적절한 환자 선택 및 수술 방법의 발달로 인해 감소하고 있다. 그러나 아직도 1차 수술 이후 및 재수술 이후에 1~2%의 감염률을 보이고 있다. 따라서 본 연구에서는 고관절 전치환술을 시행하는데 있어 감염을 일으키는 원인 및 환경 그리고 감염의 진단 및 치료에 대하여 여러 문헌을 통하여 알아보고자 하였다.

Keywords

References

  1. Charnley J, Eftekhar N. Postoperative infection in total prosthetic replacement arthroplasty of the hip-joint. With special reference to the bacterial content of the air of the operating room. Br J Surg. 1969;56:641-9. https://doi.org/10.1002/bjs.1800560902
  2. Lidwell OM. Clean air at operation and subsequent sepsis in the joint. Clin Orthop Relat Res. 1986;211:91-102.
  3. Lidwell OM, Elson RA, Lowbury EJ, et al. Ultraclean air and antibiotics for prevention of postoperative infection. A multicenter study of 8,052 joint replacement operations. Acta Orthop Scand. 1987;58:4-13. https://doi.org/10.3109/17453678709146334
  4. Salvati EA, Robinson RP, Zeno SM, Koslin BL, Brause BD, Welson PD Jr. Infection rates after 3175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered air-flow system. J Bone Joint Surg Am. 1982;64:525-35.
  5. Surin VV, Sundholm K, Ba¨ckman L. Infection after total hip replacement. With Special reference to a discharge from the wound. J Bone Joint Surg Br. 1983;65:412-8.
  6. David TS, Vrahas MS. Perioperative lower urinary tract infections and deep sepsis in patients undergoing total joint arthroplasty. J Am Acad Orthop Surg. 2000;8:66-74.
  7. Schmalzried TP, Amstutz HC, Au MK, Dorey FJ. Etiology of deep sepsis in total hip arthroplasty. The significance of hematogenous and recurrent infections. Clin Orthop Relat Res. 1992;280:200-7.
  8. Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am. 1996;78:512-23.
  9. Espehaug B, havelin LI, Engesaeter LB, Langeland N, Vollset SE. Patient- related risk factors for early revision of total hip replacements. A population register-based case-control study of 674 revised hips. Acta Orthop Scand. 1997;68:207-15. https://doi.org/10.3109/17453679708996686
  10. Gherini S, Vaughn BK, Lombardi AV Jr, Mallory TH. Delayed wound healing and nutritional deficiencies after total hip arthroplasty. Clin Orthop Relat Res. 1993;293:188-95.
  11. Ritter MA. Operating room environment. Clin Orthop Relat Res. 1999;369:103-9. https://doi.org/10.1097/00003086-199912000-00011
  12. Lidwell OM, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, Lowe D. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J (Clin Res Ed). 1982;285:10-4. https://doi.org/10.1136/bmj.285.6334.10
  13. James ET, Hunter GA, Cameron HU. Total hip revision arthroplasty: does sepsis influence the results?. Clin Orthop Relat Res. 1982;170:88-94.
  14. Nelson CL, Evarts CM, Andrish J, Marks K. Results of infected total hip replacement arthroplasty. Clin Orthop Relat Res. 1980;147:258-61.
  15. Beer KJ, Lombardi AV Jr, Mallory TH, Vaughn BK. The efficacy of suction drains after routine total joint arthroplasty. J Bone Joint Surg Am. 1991;73:584-7
  16. Garvin KL, Fitzgerald RH Jr, Salvati EA, et al. Reconstruction of the infected total hip and knee arthroplasty with gentamicin-impregnated Palacos bone cement. Instr Course Lect. 1993;42:293-302.
  17. McDonald DJ, Fitzgerald RH Jr, Ilstrup DM. Two-stage reconstruction of a total hip arthroplasty because of infection. J Bone Joint Surg Am. 1989;71:828-34.
  18. Cherney DL, Amstutz HC. Total hip replacement in the previously septic hip. J Bone Joint Surg Am. 1983;65:1256- 65.
  19. Jupiter JB, Karchmer AW, Lowell JD, Harris WH. Total hip arthroplasty in the treatment of adult hips with current or quiescent sepsis. J Bone Joint Surg Am. 1981;63: 194-200.
  20. Fitzgerald RH Jr, Jones DR. Hip implant infection: Treatment with resection arthroplasty and late total hip arthoplasty. Am J Med. 1985;78:225-8. https://doi.org/10.1016/0002-9343(85)90389-4
  21. Spangehl MJ, Masri BA, O'Connell JX, Duncan CP. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am. 1999;81: 672-83.
  22. Buttaro M, Gonza'lez Della Valle A, Piccaluga F. Psoas abscess associated with infected total hip arthroplasty. J Arthroplasty. 2002;17:230-4. https://doi.org/10.1054/arth.2002.28734
  23. Graif M, Schwartz E, Strauss S, Mouallem M, Schecter M, Morag B. Occult infection of hip prosthesis: sonographic evaluation. J Am Geriatr Soc. 1991;39:203-4.
  24. Reing CM, Richin PF, Kenmore PI. Differential bonescanning in the evaluation of a painful total joint replacement. J Bone Joint Surg Am. 1979;61:933-6.
  25. Lachiewicz PF, Rogers GD, Thomason HC. Aspiration of the hip joint before revision total hip arthroplasty. Clinical and laboratory factors influencing attainment of a positive culture. J Bone Joint Surg Am. 1996;78:749-54.
  26. Riggio MP, Dempsey KE, Lennon A, Allan D, Ramage G, Bagg J. Molecular detection of transcriptionally active bacteria from failed prosthetic hip joints removed during revision arthroplasty. Eur J Clin Microbiol Infect Dis. 2010 [Epub ahead of print].
  27. Levine MJ, Mariani BA, Tuan RS, Booth RE Jr. Molecular genetic diagnosis of infected total joint arthroplasty. J Arthroplasty. 1995;10:93-4. https://doi.org/10.1016/S0883-5403(05)80107-X
  28. Masterson EL, Masri BA, Duncan CP. Treatment of infection at the site of total hip replacement. Instr Course Lect. 1998;47:297-306.
  29. Dupont JA. Significance of operative cultures in total hip arthroplasty. Clin Orthop Relat Res. 1986;211:122-7.
  30. Bradt CM, Sistrunk WW, Duffy MC, et al. Staphylococcusaureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis. 1997;24:914-9. https://doi.org/10.1093/clinids/24.5.914
  31. Bourne RB, Hunter GA, Rorabeck CH, Macnab JJ. A sixyear follow-up of infected total hip replacements managed by Girdlestone's arthroplasty. J Bone Joint Surg Br. 1984;66:340-3.
  32. Kantor GS, Osterkamp JA, Dorr LD, Fischer D, Perry J, Conaty JP. Resection arthroplasty following infected total hip replacement arthroplasty. J Arthroplasty, 1986;1:83-9. https://doi.org/10.1016/S0883-5403(86)80045-6
  33. Kostuik J, Alexander D. Arthrodesis for failed arthroplasty of the hip. Clin Orthop Relat Res. 1984;188:173-82.
  34. Buchholz HW, Elson RA, Engelbrecht E, Lodenka¨mper H, Ro¨ ttger J, Siegel A. Management of deep infection of total hip replacement. J Bone Joint Surg Br. 1981;63-B: 342-53.
  35. Carlsson AS, Josefsson, G, Lindberg L. Revision with gentamicin-impregnated cement for deep infections in total hip arthroplasties. J Bone Joint Surg Am. 1978;60: 1059-64.
  36. Salvati EA, Chekofsky KM, Brause BD, Wilson PD Jr. Reimplantation in infection. A 12-year experience. Clin Orthop Relat Res. 1982;170:62-75.
  37. Koo KH, Yang JW, Cho SH, et al. Impregnation of vancomycin, gentamicin, and cefotaxime in a cement spacer for two-stage cementless reconstruction in infected total hip arthroplasty. J Arthroplasty. 2001;16: 882-92. https://doi.org/10.1054/arth.2001.24444
  38. Lai KA, Shen WJ, Yang CY, Lin RM, Lin CJ, Jou IM. Two-stage cementless revision THR after infection. 5 recurrences in 40 cases followed 2.5-7 years. Acta Orthop Scand. 1996;67:325-8. https://doi.org/10.3109/17453679609002324
  39. Nestor BJ, Hanssen AD, Ferrer-Gonzalez R, Fitzgerald RH Jr. The use of porous prosheses in delayed reconstruction of total hip replacements that have failed because of infection. J Bone Joint Surg Am. 1994;76:349-59.
  40. Younger AS, Duncan CP, Masri BA. Treatment of infection associated with segmental bone loss in the proximal part of the femur in two stages with use of an antibiotic-loaded interval prosthesis. J Bone Joint Surg Am. 1998;80:60-9.
  41. Pagnano MW, Trousdale RT, Hanssen AD. Outcome after reinfection following reimplantation hip arthroplasty. Clin Orthop Relat Res. 1997;338:192-204. https://doi.org/10.1097/00003086-199705000-00026
  42. Lieberman JR, Callaway GH, Salvati EA, Pellicci PM, Brause BD. Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol. Clin Orthop Relat Res. 1994;301:205-12.