Factors affecting implant retention in infected joint replacements.

ABSTRACT

BACKGROUND: There is no standard treatment for infected joint replacements. The options available are varied, and treatment choices may pose problems in relation to both efficacy and cost-effectiveness. METHODS: A retrospective review of 73 patient records identified in our departmental audit database as infected joint replacements treated at Dunedin Hospital between 1990 and 2000 was carried out. The findings were analysed in terms of outcome of primary treatment, final outcome including prosthesis retention and bacteriology. RESULTS: Of the 73 patients (50 hips and 20 knees), the majority (69%) were managed by primary surgical debridement followed by intravenous antibiotics but about one-third (34%) lost their implants because of infection. Retention of implants was higher in acute infections (85-100%) as opposed to late infections (20-50%). The microbiological analysis showed that Staphylococcus and Streptococcus caused the majority (76%) of infections. CONCLUSION: In our series, a patient with an infected joint replacement had an approximately similar 30% chance of retaining the original prosthesis, undergoing a successful revision and having no implants in situ at the end of treatment.