Treatment of subacute sepsis of the hip by antibiotics and joint replacement. Criteria for diagnosis with evaluation of twenty-six cases.

Total hip replacement fixed with acrylic cement can be successful despite past or present hip infection. Recovery of the infecting organism must be vigorously pursued, either by repeated aspirations or open biopsies. Staging the reconstruction is determined by the pathogenicity of the infecting organism, gram stain, frozen section, and above all the surgeon's observations of the condition of the wound. If in doubt, treatment of infection must take precedence over the reconstruction. Adequate antibiotic coverage should begin as soon as the diagnosis is certain and the organism identified. Antibiotics should be continued postoperatively for one month intravenously, followed by 4--8 months oral therapy, though the length of oral antibiotics could be debated. A number of authors have based their diagnosis of hip infection on clinical, roentgenographic, laboratory and bacteriologic studies. However, they have not given specific guidelines for the determination of deep hip infection. The application of the criteria outlined in this paper can distinguish superficial from deep hip infection as illustrated in 40 cases with no evidence of recurrence of infection. For the present only relative guidelines may be drawn for the treatment of subacute or recently arrested sepsis of the hip. Considering some 80,000 total hip replacements done in the U.S. in the past year, a significant number of patients will require treatment of this type and appropriate programs should be established for the welfare of the patients.