Abstract
To analyze the evolution of “Tsukayama type IV” infections (unexpected positive intraoperative cultures in hip arthroplasty -THA- exchange because of supposedly mechanical failure) treated with an extended protocol of combined oral antibiotics.
Prospective cohort: 14 patients, 66.9+/−10.9 years (40–85), 11 males (78.6%). Eleven suffered isolated cup exchange: 6/14 first cup-exchange, 4/14 second (one with a 1st Slooff impaction-grafting reconstruction and 2 with a 2nd Slooff reconstruction), 1/14 third cup-exchange. Two were operated of isolated stem exchange. One patient received a complete exchange. Cultures identified 10 epidermidis (5 methicillin-resistant -MR-), 4 aureus (3 MR), 1 Propionibacterium, 1 Enterococcus, 1 Escherichia, 1 Streptococcus, 1 Corynebacterium, and 1 Ruminococcus. Patients received 2 oral combined intracellular and biofilm-effective antibiotics for 6 months: ciprofloxacin (8 patients), rifampin (6), amoxicillin-clavulanic (3), levofloxacin (2), clindamycin (3), trimethoprim-sulfamethoxazole (2), fosfomicin (2). Follow-up: 4.5+/−4.3 years (1–14). Healing: absence of clinical, serological and radiographic signs of infection along all followup.
Infection reappeared in 1/14 patients (7.1%) with pain, distance limitation and elevated ESR&CRP; patient rejected surgery and was treated with a 2nd cycle of oral antibiotics, disappearing symptoms and serological abnormality along the following 7 years. The other 13 cases maintained normal ESR&CRP along follow-up. At the end of follow-up, 4/14 hips remain asymptomatic and with no limitation of function, 11/14 present no pain, 10/14 walk over 1Km without support, 1/11 uses a cane, 1/14 two crutches, and 2/14 a walker.
In conclusión, oral combined antibiotics may be a useful alternative therapy for Tsukayama type IV hip arthroplasty infections.
