Background
Deep infection after THA is a devastating complication that poses a challenge for the orthopaedic surgeon in terms of the best treatment strategy. Treatment methods include multiple irrigation and débridement with implant retention, single-stage revision, two-stage revision, and long-term antibiotic suppression therapy. Treatment methods may depend on the type of infection, surgeon preference, patients' medical comorbidities, and overall health status. However, the most common technique to control deep infections is staged reimplantation of the prosthetic components after a period of typically intravenous antibiotic therapy.
Although the overall infection rate for primary THA is reportedly less than 1%, the reinfection rates after two-stage reimplantation arthroplasty range from 3.2% to 13%. The recent AAOS guidelines have highlighted recent advances in our ability to diagnose and recognize infections pre-operatively. However, a number of authors have questioned the optimal duration of parenteral antibiotics during staged revision arthroplasties. Due to this, there is currently no definitive "gold standard" consensus regarding (1) whether post-reimplantation antibiotics are necessary, and (2) if they are used, are PO antibiotics effective in reducing re-infection rates.
Interestingly, at the authors' institution over the past 10 years, we noticed that some patients had been treated with longer-duration postoperative oral antibiotics after two-stage reimplantation (minimum of 2 weeks), while others had not been treated for more than 1 to 3 days. We therefore asked: (1) Did the use of postoperative oral antibiotics reduce re-infection rates after revision THA due to periprosthetic joint infection? And (2) how did this compare with the infection rate after aseptic revision procedures?