Table 3.
Literature review: surgical management of resistant hip infections
| Study | Treatment protocol | Antibiotics in cement for first stage | Successful control of infection (%) | Followup interval (months)* | Infecting organism | Number of patients |
|---|---|---|---|---|---|---|
| Lim et al. [18] | Two-stage arthroplasty with Stage 1 consisting of resection arthroplasty + cement beads (5/24), cement spacer (9/24), autoclaved prostheses reimplanted with antibiotic-impregnated cement (10/24) | Bacteria specific or 2 g vancomycin + 2 g aminoglycoside per 40 g cement | 67% (16/24) | 56 ± 31 (24–117) | MRSA (14/24), MRCNS (10/24) | 24 |
| Volin et al. [25] | Two-stage arthroplasty with Stage 1 consisting of resection arthroplasty | NA | 100% (6/6) | 48 (24–120) | MRSA (1/6), MRCNS (5/6) | 6 |
| Kilgus et al. [15] | Irrigation and débridement + polyethylene exchange (3/19); 2-stage arthroplasty (details of Stage 1 protocol not provided) (6/19); excision arthroplasty (10/19) | NA | 48% (9/19) | 27 | MRSA (11/19), MRSE (8/19) | 19 |
| Salgado et al. [22] | Débridement and retention of prosthesis (3/12); 1-stage revision arthroplasty (3/12); 2-stage revision arthroplasty with Stage 1 consisting of resection arthroplasty + cement spacer (4/12); resection arthroplasty (2/12) | Tobramycin or tobramycin + vancomycin | 50% (6/12) | 190 days (4–2279 days) | MRSA | 12 (8 hips and 4 knees) |
| Toulson et al. [24] | Two-stage arthroplasty with Stage 1 consisting of an antibiotic-impregnated cement spacer | Tobramycin and vancomycin | 100% (21/21) | 64.8 (24–203.5) | MRSE (12/21), MRSA (7/21), VRE (2/21) | 21 |
| Parvizi et al. [20] | Irrigation and débridement + polyethylene exchange (24/66); 2-stage arthroplasty with Stage 1 consisting of resection arthroplasty + antibiotic-impregnated cement spacer (42/66) | 4 g vancomycin + 3.6 g tobramycin per 40 g cement | Irrigation and débridement: 37% (13/35) (both hip and knee patients); 2-stage hip arthroplasty: 75% (24/42) | Minimum 2 years | MRSA (34/66), MRSE (32/66) | 66 |
| Leung et al. | Two-stage arthroplasty with Stage 1 consisting of resection arthroplasty + antibiotic-impregnated articulated cement spacer | 1.5 g vancomycin + 3.6 g tobramycin per 40 g cement (29/38); 1.5 g vancomycin + 3.6 g tobramycin + 0.5 g gentamicin per 40 g cement (9/38) | 79% (30/38) | 58 (24–123) | MRSA (10/38), MRSE (26/38), MRSE and MRSA (2/38) | 39 |
* Values are expressed as mean or mean ± SD, with range in parentheses; MRSA = methicillin-resistant Staphylococcus aureus; MRCNS = methicillin-resistant coagulase-negative Staphylococcus; MRSE = methicillin-resistant Staphylococcus epidermidis; VRE = vancomycin-resistant Enterococci; NA = not available.