Debridement, antibiotics, irrigation, and retention of the prosthesis with antibiotic-impregnated calcium hydroxyapatite in periprosthetic hip joint infection
Abstract Background We have developed antibiotic-impregnated calcium hydroxyapatite (CHA) as a novel antibiotic delivery system. Here, we assessed the clinical results of debridement, antibiotics, irrigation, and retention of the prosthesis (DAIR) with antibiotic-impregnated CHA for the treatment of prosthetic joint-associated infection (PJI) after total hip arthroplasty (THA). Methods Twelve patients (13 hips) treated with DAIR for PJI after THA at our institution between 1997 and 2017 were retrospectively evaluated. The study group included four men (five hips) and eight women, with an average age of 66.1 (range, 56–90) years. Four patients (five hips) had symptoms of infection within less than 3 weeks; however, eight patients had symptoms of infection over 3 weeks. All patients received DAIR with antibiotic-impregnated CHA in the surrounding bone. In one patient, the cup component revision was performed with one-stage re-implantation because of loosening, but the stem component was retained. In nine patients (10 hips), vancomycin hydrochloride was impregnated in the CHA. Results The average duration of follow-up was 8.3 (range, 2.9–18.6) years. No patients were lost to follow-up. Four patients included in this study died of other causes, with an average follow-up of 6.7 (range, 4.0–12.5) years. Intra-operative cultures were positive in 12 hips. Ten of 12 patients (11 of 13 hips) were successfully treated, and no signs of infection were observed at the latest follow-up. In two of 12 patients (two of 13 hips) for whom treatment failed, infection was successfully treated with two-stage re-implantation. Both patients had diabetes mellitus and symptoms of infection over 3 weeks. Eighty-five percent of patients were successfully treated by DAIR with antibiotic-impregnated CHA. No complications were observed with this antibiotic-impregnated CHA. Conclusions DAIR treatment with antibiotic-impregnated CHA produce a higher rate of success in patients with PJI after THA.