Palacos Gentamicin for the Treatment of Deep Periprosthetic Hip Infections

Between 1983 and 1986, 40 hip arthroplasties in 40 patients with documented deep infection were reimplanted using Palacos Gentamicin at The Hospital for Special Surgery. Palacos Gentamicin was added to the standard protocol, which included removal of the prosthesis, cement, if present, and a thorough debridement of infected and necrotic tissue, six weeks of intravenous antibiotics with a postpeak serum bactericidal titer of at least 1:8 against the infecting bacteria, followed by reimplantation of the hip. Sixteen of the patients also had the placement of gentamicin-impregnated beads at the time of prosthetic removal. All patients had a deep periprosthetic infection, 13 with Staphylococcus epidermidis, seven Staphylococcus aureus, four Streptococcus, three Enterococcus, three with gram-positive bacteria, four Escherichia coli, two Proteus, one Pseudomonas, and three anaerobic organisms. At an average follow-up period of five years (range, two to ten), two of the 40 hips (5%) developed recurrent infection. These cases recurred at one month in a patient immunocompromised by end-stage systemic lupus erythematosus (S. epidermidis) and at five months in a patient with severe titanium metallosis (S. aureus). No recurrence was noted in eight cases with gram-negative organisms or in three cases of mixed infections. No infection recurred after five months in the remaining patients before their death or last follow-up examination. Of the remaining 38 hips, 16 died of causes unrelated to the hip, leaving 21 with an average follow-up period of 7.5 years. Clinical results in these patients were 14 excellent, five good, two fair, and no poor results. Complications occurred in 12 patients: five dislocations, two recurrent infections, one sciatic nerve palsy that resolved, two cases of trochanteric bursitis, one intraoperative fracture and one case of vestibular nerve dysfunction, which was determined by a consulting neurologist to be related to intravenous administration of streptomycin as part of the treatment of the hip infection. The high success rate and lack of systemic complications attributed to Palacos gentamicin support its continued use.