Encouraging outcomes of staged, uncemented arthroplasty with short-term antibiotic therapy for treatment of recalcitrant septic arthritis of the native hip

BACKGROUND: Septic arthritis in native hip joints is a rare but serious condition in adult patients. Prompt aggressive surgical and medical treatment is a challenge, and the outcomes after delayed management can be devastating. This article reports the findings of treatment of recalcitrant cases using a standardized protocol. METHODS:: Fourteen consecutive patients (15 hips) were treated with two-stage total hip arthroplasty (THA) for septic arthritis of the hip joint over a 6-year period. All patients underwent resection arthroplasty and implantation of an antibiotic-loaded articulating spacer in the first stage, short-term systemic antibiotic therapy during the interim period, and subsequent THA without bone cement in the second stage. RESULTS:: One patient required additional debridement and spacer reinsertion before THA. The mean interim period was 12.9 weeks (range, 6-31 weeks). After an average follow-up period of 42.5 months (range, 25-72 months) after THA, there was no evidence of recurrent infection or loosening of the prostheses in any patient. The average Merle D'Aubigne and Postel hip score improved from 9.3 (range, 5-15) to 13.5 (range, 12-16) between stages and to 16.7 (range, 15-18) at the latest follow-up. CONCLUSIONS:: Two-stage uncemented THA is a reliable treatment option for adult patients with recalcitrant septic hips. If an antibiotic-loaded interim spacer is used, routine, prolonged systemic antibiotic therapy may not be necessary.