Intra-articular antibiotics : a direct approach to the treatment of infected cementless total hip arthroplasty.
| Title: | Intra-articular antibiotics : a direct approach to the treatment of infected cementless total hip arthroplasty. |
|---|---|
| Authors: | Vandeputte FJ; Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost Limburg Genk, Genk, Belgium.; European Hip Center, Westerlo, Belgium.; Gevers M; Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost Limburg Genk, Genk, Belgium.; Welters H; Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost Limburg Genk, Genk, Belgium.; Corten K; Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost Limburg Genk, Genk, Belgium.; European Hip Center, Westerlo, Belgium. |
| Source: | The bone & joint journal [Bone Joint J] 2025 Jun 01; Vol. 107-B (6 Supple B), pp. 3-8. Date of Electronic Publication: 2025 Jun 01. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: British Editorial Society of Bone & Joint Surgery Country of Publication: England NLM ID: 101599229 Publication Model: Electronic Cited Medium: Internet ISSN: 2049-4408 (Electronic) Linking ISSN: 20494394 NLM ISO Abbreviation: Bone Joint J Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London : British Editorial Society of Bone & Joint Surgery |
| MeSH Terms: | Arthroplasty, Replacement, Hip*/adverse effects ; Arthroplasty, Replacement, Hip*/methods ; Prosthesis-Related Infections*/drug therapy ; Prosthesis-Related Infections*/surgery ; Anti-Bacterial Agents*/administration & dosage ; Anti-Bacterial Agents*/therapeutic use ; Hip Prosthesis*/adverse effects; Humans ; Male ; Female ; Aged ; Middle Aged ; Reoperation ; Treatment Outcome ; Aged, 80 and over ; Injections, Intra-Articular ; Follow-Up Studies ; Retrospective Studies ; Debridement |
| Abstract: | Aims: The use of intra-articular antibiotics in the treatment of periprosthetic joint infection (PJI) can achieve a concentration which is sufficient to eradicate a biofilm. This may mitigate the need for removal of infected but well-fixed cementless components of a total hip arthroplasty (THA). However, the use of percutaneous catheters might lead to multiresistance or persistent multiorganism infections. The aim of this study was to report the results of a series in which an intra-articular antibiotic infusion was added to a single-stage revision for infected cementless THAs.; Methods: A total of 18 patients underwent 18 single-stage revision THAs which were performed for acute (n = 9) or chronic (n = 9) PJI, following a primary (n = 12) or revision (n = 6) cementless THA. After an extensive debridement, modular components were replaced, but all well-fixed components were retained. Two Hickmann catheters were introduced into the joint space, through which intra-articular antibiotics were introduced for two weeks. Intravenous antibiotics were also administered during this time, followed by oral antibiotics until three months after surgery.; Results: At a mean follow-up of 5.4 years (3.3 to 7.19), all patients had a normal ESR and white blood cell count. The CRP remained slightly elevated in three patients, although they were pain-free and showed no signs of infection. No patient developed antibiotic-related renal or systemic dysfunction postoperatively.; Conclusion: We found that for the treatment of an infected cementless THA, retention of well-fixed components was feasible, with the addition of intra-articular antibiotics to a standard single-stage regime. None of the 18 patients had persistent infection or catheter-induced drug resistance, at a mean follow-up of 5.4 years.; (© 2025 Vandeputte et al.) |
| Competing Interests: | F-J. Vandeputte reports consulting fees from Zimmer Biomet, Johnson & Johnson, and MedEnvision, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Johnson & Johnson, and support for attending meetings and/or travel from Arthrex, all of which are unrelated to this study. K. Corten reports royalties or licenses, consulting fees, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events, patents planned, issued or pending from Depuy Synthes and MedEnvision, and stock or stock options in MedEnvision, all of which are unrelated to this study. |
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| Substance Nomenclature: | 0 (Anti-Bacterial Agents) |
| Entry Date(s): | Date Created: 20250531 Date Completed: 20250531 Latest Revision: 20250531 |
| Update Code: | 20260130 |
| DOI: | 10.1302/0301-620X.107B6.BJJ-2024-0853.R1 |
| PMID: | 40449545 |
| Database: | MEDLINE |
Journal Article