Prosthetic hip infection in patients with liver cirrhosis: An outcome analysis

Background: Liver cirrhosis is a well-known co-morbidity in prosthetic hip infection (PHI), but the results of treatment and prognostic factors that predict outcomes of PHI in cirrhotic patients have not been studied. Methods: We performed a cohort study of patients with liver cirrhosis who contracted PHI and were treated at our institution between January 1990 and December 2004. Results: Of 349 first-time episodes of PHI during the study period, 33 (9.5%) occurred in patients with liver cirrhosis. Debridement with retention of the prosthesis (DWROP) was the initial treatment modality for 24 (73%) episodes of PHI and cured the infection in seven (29%). A shorter median duration of symptoms (5 vs. 14 days; p=0.007) and absence of a sinus tract (p= 0.02) were associated with successful treatment. Excision arthroplasty (EA) was required in 26 (79%) episodes and eradicated PHI in 24 (92%). In 20 patients who had reimplantation of a new prosthesis, the infection recurred in six (30%). Patients who developed hepatic decompensation after reimplantation had a significantly higher risk of recurrent PHI than those who did not (relative risk 7.5; 95% confidence interval 4.8-9.5; p=0.018). Conclusions: Liver cirrhosis is a common co-morbidity in patients with PHI treated at our institution. DWROP should be considered only when there is no sinus tract and the duration of symptoms is very short (less than 10 days). EA is an effective procedure to cure infection. However, reimplantation of hip prosthesis in these patients carries a high risk of infection recurrence, especially in those who develop hepatic decompensation.