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Infected Total Hip Arthroplasty: Diagnosis and Treatment

Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia.

The diagnosis of a deep infection complicating total hip arthroplasty is not difficult in most patients. When the diagnosis is not evident on the basis of the medical history, physical examination, routine blood work, and plain radiographs, indium-111-labeled leukocyte scintigraphy can be diagnostic. New immunologic techniques may allow differentiation of aseptic loosening from septic loosening of a painful total hip arthroplasty. Once the diagnosis of a deep infection about a total hip arthroplasty has been established, there are several treatment options. Oral antimicrobial therapy combining rifampin with a fluoroquinolone may prove to be an attractive alternative to surgical intervention in the treatment of some staphy-lococcal infections. If the causal microorganism is considered to be less virulent and does not elaborate glycocalyx, a one-stage procedure for reconstructing the hip with a cemented total hip arthroplasty incorporating antibiotics that are cidal to the microorganism has been successful in as many as 90% of patients. If the causal microorganism is considered to be virulent, a two-stage procedure with a prolonged interval between the Girdlestone resection arthroplasty and the second-stage reconstructive procedure is the treatment of choice.