Can periprosthetic hip joint infections be successfully managed by debridement and prosthesis retention?

Table 1 Overview of 11 studies reporting about prosthesis retention at the site of periprosthetic hip joint infections with regard to publication year, number of patients treated, type of infection, and level of evidence

Ref.	Publication year	Number of patients	Type of infection	Level of evidence
Aboltins et al[6]	2007	13	7 early1	IV
			6 late
Aboltins et al[7]	2013	19	All early1	III
Anagnostakos et al[8]	2010	12	All late2	IV
Choi et al[9]	2012	28	All early3	III
Crockarell et al[10]	1998	42	19 early3	IV
			19 late
			4 acute hematogenous
Kelm et al[11]	2009	28	All early2	IV
Klouche et al[12]	2011	12	All early3	IV
Lee et al[13]	2013	19	10 late3	IV
			9 acute hematogenous
Tsukayama et al[2]	1996	41	35 early3	IV
			6 acute hematogenous
Waagsbø et al[3]	2009	40	30 early4	IV
			10 late
Westberg et al[14]	2013	38	Early3	IV

¹Early < 3 mo after surgery; late > 3 mo after surgery;

²Early < 6 wk after surgery; late > 6 wk after surgery;

³Early < 4 wk after surgery; late > 4 wk after surgery; Acute hematogenous > 4 wk after surgery due to bacteremia;

⁴Early < 4 wk after surgery; late > 4 wk after surgery.

Table 2 Overview of 11 studies reporting about prosthesis retention at the site of periprosthetic hip joint infections with regard to surgical treatment modalities, -complications, infection eradication rate and length of follow-up

Ref.	Surgical treatment procedure	Surgical complications	Infection eradication rate
Aboltins et al[6]	Debridement, lavage,	1/13 aseptic prosthesis loosening	92.30%
	Change of PE-liner
	[Median = 1 (1-4)]
Aboltins et al[7]	Debridement, lavage,	N.c.d.	89.50%
	Change of PE-liner
	[Median = 3 (3-6)]
Anagnostakos et al[8]	Acetabular cup removal +	2/12 draining sinus	91.60%
	Spacer head onto retained stem	After spacer head implantation;
	Mean implantation period 88 (35-270) d	1/12 spacer dislocation;
		3/12 prosthesis dislocation
Choi et al[9]	19/28 debridement, irrigation,	5/28 staged revision,	50%
	Change of PE-liner	6/28 repeated debridement,
	9/28 debridement, irrigation,	4/28 resection arthroplasty
	No change of PE-liner
Crockarell et al[10]	Debridement	1/42 prosthesis dislocation,	21%1
		1/42 periprosthetic femoral fracture,
		1/42 exitus due to sepsis
Kelm et al[11]	Debridement, pulsatile lavage,	None	92.80%
	Change of PE-liner,
	Vacuum-assisted closure
Klouche et al[12]	Debridement, irrigation	n.r.	75%
	Change of PE-liner and femoral head
Lee et al[13]	Acetabular cup removal +	n.r.	89.50%
	Spacer head onto retained stem
Tsukayama et al[2]	Debridement, change of PE-liner	1/35 acetabular component loosening	71% (early)
		2/6 acetabular component loosening	50% (acute hematogenous)
Waagsbø et al[3]	Debridement + prosthesis retention	n.r.	67.50%
Westberg et al[14]	Debridement, pulsatile lavage,	8/38 prosthesis dislocation	71%
	Change of modular prosthesis components

PE: Polyethylene; N.c.d.: Not clearly described; n.r.: Not reported;

¹4/19 early successful, 2/4 acute hematogenous, 0/19 late.

Table 3 Overview of 11 studies reporting about prosthesis retention at the site of periprosthetic hip joint infections with regard to the systemic antibiotic therapy

Study	Systemic antibiotic therapy
Aboltins et al[6]	All intravenous glycopeptide or beta-lactam for median 10 (3-29) d
	All oral rifampicin+fusidic acid for median 17 (6-33) mo
Aboltins et al[7]	All intravenous glycopeptide + beta-lactam for median 15 (12-34) d
	All oral rifampicin + fucidic acid or ciprofloxacin for median 356 (230-395) d
Anagnostakos et al[8]	All intravenous for 4 wk + oral for 2 wk
Choi et al[9]	All intravenous for 6 wk
Crockarell et al[10]	41/42 intravenous for 29 (2-72) d
	26/42 oral after iv For 70 (5-376) d; 3/42 chronic suppression
Kelm et al[11]	Intravenous for 2 wk followed by oral for 2 wk
Klouche et al[12]	Intravenous for 6 wk followed by oral for 6 wk
Lee et al[13]	Intravenous for 4-6 wk
Tsukayama et al[2]	Early: intravenous for 4 wk; acute hematogenous: intravenous for 6 wk
Waagsbø et al[3]	Overall duration of antibiotic therapy 0.1 (8.2-14.2) wk, of which intravenous 4.4 (4.2-6.1) wk
Westberg et al[14]	Overall duration of antibiotic therapy 7 (3-39) wk