Do resistant organisms affect success of two-stage reimplantation for prosthetic hip infections?

Background Infected total hip arthroplasty (THA) generates substantial personal, social, and economic burden. Revision procedures for infection are associated with longer operative times, more blood loss, and more complications compared with revisions for aseptic loosening or primary THA. Methods We retrospectively evaluated 44 patients who had THA and underwent a two-stage revision for prosthetic hip infection with methicillin-resistant or vancomycin-resistant organisms between 1995 and 2005. The minimum follow-up was 24 months (average, 45.2 months; range, 24-130 months). Treatment was considered a failure if a two-stage procedure failed to control the infection and required repeat surgery. Results A two-stage revision procedure with culture-specific antibiotics controlled the infection in 29 of the 44 patients (66%). Of the remaining 15 patients, 10 (23%) had a reinfection, and five (11%) had a relapse with the same organism. Conclusions Infection was controlled in two-thirds of the patients with resistant infections using a two-stage approach. These data highlight the importance of considering the virulence of infecting organisms when treating prosthetic hip infections. The likelihood of controlling the infection with a single two-stage procedure is inferior to that reported in the literature for susceptible organisms.