[The infected hip prosthesis].

Abstract

Therapy of infected hip prosthesis should always be based on a structured treatment concept. When short-termed early infection is present or impending, with meticulous debridement of the soft tissue surroundings, the implant may be left in place. Chronic infection (>30 days) should lead to complete removal of implant and cement. A one-staged revision of the implant may be considered for patients without additional chronic disease, good vascularization of soft tissue and bones and bacteria susceptible to antibiotics. In most cases though two-staged revision is indicated. The interval between implant removal and re-implantation ranges between one and four months. Re-implantation should only be performed when laboratory parameters are normalized and the local wound site has turned to an unsuspicious condition. By insertion of a cement spacer during the interval period soft tissue shortening and local scar formation can be prevented. Parenteral antibiotics should be applied for four to six weeks. In patients with reduced general health state and extremely severe infection permanent resection of the hip or limp ablation may be indicated.