Infection is a potential complication of any surgical procedure, including total hip replacement. Infection occurs when bacteria attach in and around the surface of the prosthesis. Infection may occur while you are in the hospital or after you go home. It may even occur years later.
If a total hip replacement becomes infected, it can be painful and the implant may begin to lose its attachment to the bone. Even if the implant remains properly fixed to the bone, there may still be pain, instability, and drainage from the infection. Because bacteria cannot be easily eliminated from a joint replacement with antibiotics alone, revision surgery is usually necessary.
Revision surgery for infection can be done in different ways. To determine which procedure is best for you, your doctor will consider a number of factors, including:
- The type of bacteria
- The duration and severity of the infection
- Your preference for a specific treatment
Debridement In this procedure, your doctor will open up your hip, wash out the bacteria, and exchange the ball and plastic liner. The metal implants that are firmly attached to the bone are left in place. After debridement, you will receive intravenous antibiotics for several weeks to help cure the infection.
Staged surgery. In some cases, the implants must be completely removed. If the implants are removed to treat the infection, your doctor will usually perform the revision in two separate surgeries.
In the first surgery, your doctor will remove the implants and place a temporary cement spacer in your hip. This spacer is treated with antibiotics to help fight the infection and will remain in your hip for several weeks. During this time, you will also receive intravenous antibiotics.
When the infection has been cleared, your doctor will perform a second surgery to remove the antibiotic spacer and insert a new prosthesis. In general, removing the implant leads to a higher chance of curing the infection, but is associated with a longer recovery.
In some cases, your doctor may be able to remove the implants, wash out the hip, and place a new prosthesis all in the same operation. This procedure, which is called a one-stage exchange, may be appropriate in limited situations.