VACUUM-ASSISTED CLOSURE IN THE TREATMENT OF EARLY HIP JOINT INFECTIONS

Abstract

Introduction: The aim of the present study was to evaluate the efficacy of the vacuum–assisted closure (V.A.C.) therapy in the treatment of early hip joint infections.

Patients and Methods: 28 patients (11 m/17 f; mean age 71 y. [43–84]) with early hip joint infections have been treated by means of the V.A.C.–therapy. At least one surgical procedure [1–7] has been unsuccessfully performed for infection treatment prior to V.A.C. – application. Pathogen organisms could have been isolated in 22/28 wounds. During revision, cup inlay and prosthesis head have been exchanged and 1–3 polyvinylalcohol sponges inserted into the wound cavity/periprosthetically at an initial continuous pressure of 200 mm Hg. Postoperatively, a systemic antibiosis was given according to antibiogram.

Results: 48–72 h after surgery an alteration from haemorrhagic to serous fluid was observed in the V.A.C.-canister. Afterwards, the pressure was decreased to 150 mm Hg and remained at this level till sponge removal. After a mean period of 9 [3–16] days the inflammation parameters have been retrogressive and the sponges were removed. An infection eradication could be achieved in 26/28 cases. In the two remaining cases the infected prosthesis had to be explanted and a gentamicin-vancomycin-loaded spacer has been implanted, respectively. At a total mean follow-up of 36 [12–87] months no reinfection or infection persistence was observed.

Discussion: The V.A.C.-system can be a valuable contribution in the treatment of early joint infections when properly used. Indications should be early infections with well-maintained soft-tissues for retention of the vacuum.