Persistent infection associated with residual cement after resection arthroplasty of the hip

Abstract

Background: The danger of residual bone cement after resection of infected prosthetic components is controversial.

Patients and methods: We analyzed 10 patients with infected total hip prosthesis who had been treated previously with resection arthroplasty and antibiotics and who had persistent infection with residual cement. In 9 patients, surgical debridement with resection of all the PMMA was performed, and adequate intravenous antibiotics were administered. 1 patient refused surgical treatment, but accepted antibiotics.

Results: At an average of 4 (1-18) years of follow-up, 8 patients had no signs or symptoms of recurrent infection. 1 severely immunodeficient patient died 2 years after the removal of residual cement, for reasons other than his hip. The patient who refused surgical treatment continues to have an active sinus 4 years after first consultation.

Interpretation: Residual cement may be responsible for chronic infection. At resection arthroplasty, as part of the treatment of an infected hip arthroplasty, all devitalized or foreign material must be removed.