Infected Total Hip Replacement

Infection following total hip replacement surgery is thankfully very rare but can be very problematic.  We breakdown infections into those which are simple post-operative wound infections and those that are deep and involve the hip joint itself.

Superficial Wound Infections

The good news here is that these usually respond to a course of antibiotics and settle without the need for surgery.  On occasion it may be necessary to tidy up the wound with a short operation but this is relatively straight forward with a good outcome.  It is important to note that if you do develop a skin infection around your hip wound immediately following surgery you should be reviewed by your surgeon or a member of the team prior to starting antibiotics.  Most GPs will ask for the orthopaedic team to see you in A+E in this situation and this allows us to assess the risk to your hip.  We may simply start antibiotics but this assessment is important.

Peri-prosthetic infection (Infected hip replacement)

Deep infection following total hip replacement surgery is rare but is a difficult problem to deal with.  It is treatable but usually requires at least one procedure, or sometimes a series of procedures to change the implants and eradicate the infection.  Sadly antibiotics alone are not sufficient to clear infection from the components of the hip replacement.  There are several strategies outlined below :

  • Debridement and implant retention (DAIR)

This technique was pioneered in Oxford and is usually performed for infections that occur acutely and present within 8 weeks within the onset of infection.  The hip joint is washed out, infected tissue removed and the ball of the femur and liner of the socket changed to attempt to eradicate the infection.  This is then supplemented by a long course of antibiotics.  This is the least invasive form of revision for infection with success in 75% of cases.

  • Single stage revision

Similar to DAIR, but all components are removed and new components implanted within the same sitting. This is also supplemented with a long course of antibiotic therapy with successful eradication of infection in up to 85% of cases.

  • Two stage revision

The most rigorous form of revision for infection requires removal of all infected tissue and implants and leaves you without a hip until we are confident all infection has been eradicated.  At an interval of between 6 and 12 weeks of antibiotic therapy a new hip prosthesis is implanted.  This has the best chances of eradication of infection (90%) but is a far bigger procedure to go through in terms of strain on the body.

All of the strategies above have certain indications and are not recommended in all cases.  Mr Barksfield has expertise in hip revision surgery and will counsel you as to which strategy would suit best.