SPECIAL ARTICLE  HIP PERIPROSTHETIC JOINT INFECTIONS: PREVENTION, DIAGNOSIS AND TREATMENT 

Minerva Orthopedics 2022 August;73(4):409-15

DOI: 10.23736/S2784-8469.21.04173-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Debridement, antibiotic, pearls, irrigation and retention of the implant and other local strategies on hip periprosthetic joint infections

Stefano GHIRARDELLI ^{1, 2, 3}, Georgios TOULOUPAKIS ², Guido ANTONINI ², Bruno VIOLANTE ³, Andrea FIDANZA ¹, Pier F. INDELLI ¹ ✉

¹ Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA, USA; ² Department of Orthopedic Surgery, San Carlo Borromeo Hospital, Milan, Italy; ³ Department of Orthopedic Surgery, IRCCS Sant’Ambrogio, Milan, Italy

Periprosthetic joint infections (PJI) represent a catastrophic consequence following total joint arthroplasty, due to a very high morbidity and mortality. If chronic infections are regularly treated with single-stage or dual-stage explant, there is no consensus in the literature on which is the best approach to treat acute infections. This article proposes a new surgical technique to treat PJI in an acute setting, characterized by identification or isolation of the micro-organism. Debridement, antibiotic pearls, retention of the implant constitute a new, multimodal, surgical approach to PJI after total hip arthroplasty (THA). The authors also reviewed the literature on alternative strategies currently utilized to treat PJI following THA: debridement, antibiotics, implant retention, hydrogels, nanoparticles with bactericidal effects, antimicrobial peptides, all represent effective and promising strategies to prevent explant of the components. Nevertheless, more basic science studies and advancements in surgical techniques and technology applications are still needed before retention of a previously infected implant will become standard of care.

KEY WORDS: Arthroplasty, replacement, hip; Infections; Therapeutics