G Renard, J-M Laffosse, M Tibbo, T Lucena, E Cavaignac, J-L Rouvillain, Ph Chiron, M Severyns, N Reina (Toulouse, Fort de France, Rochester)
Purpose : There is no consensus regarding systematic screening for infection in aseptic revision total hip arthroplasty (THA). The hypothesis being that systematic sampling allows for detection of latent infections requiring specific treatment, the purpose of the present study was to assess the rate of unexpected periprosthetic joint infections in THA revisions, and describe their typical evolution and management in an academic institution.
Method : Bacteriological samples from 523 aseptic THA revisions performed for five years were analyzed.
Results : The incidence of unexpected infection and contamination were 7% (36 cases), and 8% (42 cases), respectively. Among unexpected infections, the primary reasons for revision were dislocation (42%), aseptic loosening (25%), fracture (19%), and other (14%). The infection rate in the dislocation group was significantly higher than that of other reasons for revision (p<0.001). Antibiotic therapy was initiated in 34 patients. After 5 years of follow-up, 53% were infection-free (18 patients), 9% had failed treatment (3 patients), 26% had been lost to follow-up (9 patients), and 4 patients died of other causes (12%).
Conclusion : Systematic preoperative assessment for infection in revision hip arthroplasty is useful to diagnose latent infections, especially among revisions for instability.