Assessment of patient selection criteria for treatment of the infected hip arthroplasty.

In a group of 37 infected hip arthroplasties (36 patients) treated consecutively between January 1997 and October 1999, the feasibility of published patient selection criteria for direct exchange arthroplasty was tested. These criteria include the requirement of a healthy patient with good soft tissues, minimal femoral bone loss, and an organism identified preoperatively as an antibiotic sensitive gram-positive organism. After assignment of the selection criteria, only four patients (four hips) (11%) were deemed potential candidates for a direct exchange procedure. Infected arthroplasties excluded from a primary exchange included 14 patients (15 hips) with gram-negative or methicillin-resistant gram-positive organisms obtained from preoperative joint aspirations, 10 patients (10 hips) with moderate or severe femoral bone loss, four patients (four hips) who required a proximal femoral osteotomy for component removal, two patients (two hips) with poor health status, and two patients (two hips) with poor soft tissues. Because of the increasing emergence of antibiotic-resistant bacteria and an increased prevalence of revision arthroplasties with associated bone loss, the feasibility of published selection criteria for direct exchange are limited. A philosophy of delayed reconstruction for the treatment of the infected hip arthroplasty seems most appropriate in the current era of patient treatment.