{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:42:27Z","timestamp":1787755347399,"version":"build-2784847793"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2017,12,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There are conflicting data on the results of irrigation and debridement with component retention in patients with acute periprosthetic hip infections. The goals of this study were to examine contemporary results of irrigation and debridement with component retention for acute infection after primary hip arthroplasty and to identify host, organism, antibiotic, or implant factors that predict success or failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Ninety hips (57 total hip arthroplasties and 33 hemiarthroplasties) were diagnosed with acute periprosthetic hip infection (using strict criteria) and were treated with irrigation and debridement and component retention between 2000 and 2012. The mean follow-up was 6 years. Patients were stratified on the basis of McPherson criteria. Hips were managed with irrigation and debridement and retention of well-fixed implants with modular head and liner exchange (70%) or irrigation and debridement alone (30%). Seventy-seven percent of patients were treated with chronic antibiotic suppression. Failure was defined as failure to eradicate infection, characterized by a wound fistula, drainage, intolerable pain, or infection recurrence caused by the same organism strain; subsequent removal of any component for infection; unplanned second wound debridement for ongoing deep infection; and\/or occurrence of periprosthetic joint infection-related mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Treatment failure occurred in 17% (15 of 90 hips), with component removal secondary to recurrent infection in 10% (9 of 90 hips). Treatment failure occurred in 15% (10 of 66 hips) after early postoperative infection and 21% (5 of 24 hips) after acute hematogenous infection (p = 0.7). Patients with McPherson host grade A had a treatment failure rate of 8%, compared with 16% (p = 0.04) in host grade B and 44% in host grade C (p = 0.006). Most treatment failures (12 of 15 failures) occurred within the initial 6 weeks of treatment; failures subsequent to 6 weeks occurred in 3% of those treated with chronic antibiotic suppression compared with 11% of those who were not treated with suppression (hazard ratio, 4.0; p = 0.3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The success rate was higher in this contemporary series than in many previous series. Systemic host grade A was predictive of treatment success.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.16.01103","type":"journal-article","created":{"date-parts":[[2017,12,6]],"date-time":"2017-12-06T11:05:58Z","timestamp":1512558358000},"page":"2011-2018","source":"Crossref","is-referenced-by-count":97,"title":["Irrigation and Debridement with Component Retention for Acute Infection After Hip Arthroplasty"],"prefix":"10.2106","volume":"99","author":[{"given":"Andrew J.","family":"Bryan","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew P.","family":"Abdel","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas L.","family":"Sanders","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven F.","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arlen D.","family":"Hanssen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1422-0306","authenticated-orcid":false,"given":"Daniel J.","family":"Berry","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"8","key":"bib1-20230810","first-page":"27","article-title":"Economic burden of periprosthetic joint infection in the United States","author":"Kurtz","year":"2012","journal-title":"J Arthroplasty"},{"issue":"1","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1007\/s11999-015-4520-6","article-title":"Short-term risk of revision THA in the Medicare population has not improved with time","volume":"474","author":"Bozic","year":"2016","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"bib3-20230810","first-page":"24","article-title":"Prosthetic joint infection risk after total hip arthroplasty in the Medicare population","author":"Ong","year":"2009","journal-title":"J Arthroplasty"},{"issue":"2","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1007\/s11999-012-2595-x","article-title":"Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality","volume":"471","author":"Berend","year":"2013","journal-title":"Clin Orthop Relat Res."},{"issue":"11","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"2206","DOI":"10.1016\/j.arth.2014.04.019","article-title":"Mortality of elderly patients after two-stage reimplantation for total joint infection: a case-control study","volume":"29","author":"Webb","year":"2014","journal-title":"J Arthroplasty"},{"issue":"7","key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"847","DOI":"10.2106\/00004623-197759070-00001","article-title":"Deep wound sepsis following total hip arthroplasty","volume":"59","author":"Fitzgerald","year":"1977","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/S0883-5403(88)80075-5","article-title":"Prolonged suppression of infection in total hip arthroplasty","volume":"3","author":"Goulet","year":"1988","journal-title":"J Arthroplasty"},{"key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/00003086-199108000-00003","article-title":"Infections at the site of a hip implant. Successful and unsuccessful management","volume":"269","author":"Collins","year":"1991","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib9-20230810","doi-asserted-by":"crossref","first-page":"512","DOI":"10.2106\/00004623-199604000-00005","article-title":"Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections","volume":"78","author":"Tsukayama","year":"1996","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib10-20230810","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1111\/j.1469-0691.2007.01691.x","article-title":"Treatment of staphylococcal prosthetic joint infections with debridement, prosthesis retention and oral rifampicin and fusidic acid","volume":"13","author":"Aboltins","year":"2007","journal-title":"Clin Microbiol Infect"},{"issue":"8","key":"bib11-20230810","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1007\/s11999-010-1293-9","article-title":"A two-stage retention d\u00e9bridement protocol for acute periprosthetic joint infections","volume":"468","author":"Estes","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib12-20230810","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1302\/0301-620X.93B1.25120","article-title":"Cementless revision for infected total hip replacements","volume":"93","author":"Kim","year":"2011","journal-title":"J Bone Joint Surg Br."},{"issue":"2","key":"bib13-20230810","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.otsr.2011.01.002","article-title":"Infected total hip arthroplasty treated by an irrigation-debridement\/component retention protocol. A prospective study in a 12-case series with minimum 2 years\u2019 follow-up","volume":"97","author":"Klouche","year":"2011","journal-title":"Orthop Traumatol Surg Res."},{"issue":"4","key":"bib14-20230810","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1086\/499234","article-title":"Outcome of prosthetic joint infections treated with debridement and retention of components","volume":"42","author":"Marculescu","year":"2006","journal-title":"Clin Infect Dis"},{"issue":"6","key":"bib15-20230810","first-page":"26","article-title":"Irrigation and debridement for periprosthetic infections: does the organism matter?","author":"Odum","year":"2011","journal-title":"J Arthroplasty"},{"issue":"8","key":"bib16-20230810","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1007\/s11999-010-1291-y","article-title":"Irrigation and d\u00e9bridement and prosthesis retention for treating acute periprosthetic infections","volume":"468","author":"Van Kleunen","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"19","key":"bib17-20230810","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1001\/jama.279.19.1537","article-title":". Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial","volume":"279","author":"Zimmerli","year":"1998","journal-title":"JAMA"},{"issue":"15","key":"bib18-20230810","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.2106\/JBJS.N.00999","article-title":"Chronic suppression of periprosthetic joint infections with oral antibiotics increases infection-free survivorship","volume":"97","author":"Siqueira","year":"2015","journal-title":"J Bone Joint Surg Am."},{"key":"bib19-20230810","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/00003086-200210000-00003","article-title":"Periprosthetic total hip infection: outcomes using a staging system","volume":"403","author":"McPherson","year":"2002","journal-title":"Clin Orthop Relat Res."},{"issue":"5","key":"bib20-20230810","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1111\/j.1469-0691.2006.01378.x","article-title":"Outcome of prosthetic knee-associated infection: evaluation of 40 consecutive episodes at a single centre","volume":"12","author":"Laffer","year":"2006","journal-title":"Clin Microbiol Infect"},{"issue":"11","key":"bib21-20230810","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.1007\/s11999-011-2102-9","article-title":"New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society","volume":"469","author":"Parvizi","year":"2011","journal-title":"Clin Orthop Relat Res."},{"issue":"9","key":"bib22-20230810","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.2106\/JBJS.G.01255","article-title":"Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty","volume":"90","author":"Schinsky","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib23-20230810","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1007\/s11999-013-3089-1","article-title":"The 2013 Frank Stinchfield Award: diagnosis of infection in the early postoperative period after total hip arthroplasty","volume":"472","author":"Yi","year":"2014","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib24-20230810","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/cid\/cis966","article-title":"Infectious Diseases Society of America. Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America","volume":"56","author":"Osmon","year":"2013","journal-title":"Clin Infect Dis"},{"issue":"7","key":"bib25-20230810","doi-asserted-by":"crossref","first-page":"2374","DOI":"10.1007\/s11999-013-2866-1","article-title":"Success after treatment of periprosthetic joint infection: a Delphi-based international multidisciplinary consensus","volume":"471","author":"Diaz-Ledezma","year":"2013","journal-title":"Clin Orthop Relat Res."},{"issue":"2","key":"bib26-20230810","first-page":"105","article-title":"Periprosthetic joint infection: modern aspects of prevention, diagnosis, and treatment","volume":"28","author":"Frank","year":"2015","journal-title":"J Knee Surg"},{"issue":"9","key":"bib27-20230810","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.1007\/s11999-010-1325-5","article-title":"Retrospective analysis of infection rate after early reoperation in total hip arthroplasty","volume":"468","author":"Darwiche","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"5","key":"bib28-20230810","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1007\/s00264-013-2265-y","article-title":"Periprosthetic joint infection\u2014effect on quality of life","volume":"38","author":"Helwig","year":"2014","journal-title":"Int Orthop"},{"issue":"8","key":"bib29-20230810","doi-asserted-by":"crossref","first-page":"841","DOI":"10.3928\/0147-7447-19910801-07","article-title":"Suppressive antibiotic therapy in chronic prosthetic joint infections","volume":"14","author":"Tsukayama","year":"1991","journal-title":"Orthopedics"},{"key":"bib30-20230810","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1097\/01.blo.0000087321.60612.cf","article-title":"Long-term suppression of infection in total joint arthroplasty","volume":"414","author":"Rao","year":"2003","journal-title":"Clin Orthop Relat Res."},{"key":"bib31-20230810","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1097\/00003086-200211000-00021","article-title":"Results of periprosthetic hip and knee infections caused by resistant bacteria","volume":"404","author":"Kilgus","year":"2002","journal-title":"Clin Orthop Relat Res."},{"issue":"6","key":"bib32-20230810","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1007\/s00264-015-2753-3","article-title":"Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome","volume":"39","author":"Triantafyllopoulos","year":"2015","journal-title":"Int Orthop"},{"key":"bib33-20230810","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1097\/00003086-198911000-00020","article-title":"Long-term results of various treatment options for infected total knee arthroplasty","volume":"248","author":"Morrey","year":"1989","journal-title":"Clin Orthop Relat Res."},{"key":"bib34-20230810","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1097\/00003086-199112000-00015","article-title":"Implant salvage in infected total knee arthroplasty","volume":"273","author":"Burger","year":"1991","journal-title":"Clin Orthop Relat Res."},{"issue":"7","key":"bib35-20230810","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/S0883-5403(03)00288-2","article-title":"Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty","volume":"18","author":"Deirmengian","year":"2003","journal-title":"J Arthroplasty"},{"issue":"6","key":"bib36-20230810","doi-asserted-by":"crossref","first-page":"553","DOI":"10.4065\/74.6.553","article-title":"Staphylococcus aureus prosthetic joint infection treated with prosthesis removal and delayed reimplantation arthroplasty","volume":"74","author":"Brandt","year":"1999","journal-title":"Mayo Clin Proc."},{"issue":"6","key":"bib37-20230810","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.jinf.2013.07.030","article-title":"Infected hip hemiarthroplasties and total hip arthroplasties: differential findings and prognosis","volume":"67","author":"Lora-Tamayo","year":"2013","journal-title":"J Infect"},{"issue":"8","key":"bib38-20230810","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1007\/s10096-014-2091-1","article-title":"Are hip hemiarthroplasty and total hip arthroplasty infections different entities? The importance of hip fractures","volume":"33","author":"del Toro","year":"2014","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"1","key":"bib39-20230810","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.jhin.2011.04.022","article-title":"Group B streptococcus in prosthetic hip and knee joint-associated infections","volume":"79","author":"Sendi","year":"2011","journal-title":"J Hosp Infect"},{"issue":"2","key":"bib40-20230810","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s15010-012-0325-7","article-title":"Factors associated with rifampin resistance in staphylococcal periprosthetic joint infections (PJI): a matched case-control study","volume":"41","author":"Achermann","year":"2013","journal-title":"Infection"},{"issue":"11","key":"bib41-20230810","doi-asserted-by":"crossref","first-page":"3043","DOI":"10.1007\/s11999-011-1910-2","article-title":"Infection control rate of irrigation and d\u00e9bridement for periprosthetic joint infection","volume":"469","author":"Koyonos","year":"2011","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib42-20230810","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1007\/s11999-012-2373-9","article-title":"Failure of irrigation and d\u00e9bridement for early postoperative periprosthetic infection","volume":"471","author":"Fehring","year":"2013","journal-title":"Clin Orthop Relat Res."},{"issue":"7","key":"bib43-20230810","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.arth.2010.01.104","article-title":"Irrigation and debridement in the management of prosthetic joint infection: traditional indications revisited","volume":"25","author":"Azzam","year":"2010","journal-title":"J Arthroplasty"},{"issue":"5","key":"bib44-20230810","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1093\/clinids\/24.5.914","article-title":"Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention","volume":"24","author":"Brandt","year":"1997 May","journal-title":"Clin Infect Dis"},{"issue":"9","key":"bib45-20230810","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.2106\/00004623-199809000-00009","article-title":"Treatment of infection with d\u00e9bridement and retention of the components following hip arthroplasty","volume":"80","author":"Crockarell","year":"1998","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib46-20230810","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1016\/j.arth.2016.10.011","article-title":"A standardized regimen for the treatment of acute postoperative infections and acute hematogenous infections associated with hip and knee arthroplasties","volume":"32","author":"Fink","year":"2017","journal-title":"J Arthroplasty"},{"issue":"8","key":"bib47-20230810","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1080\/00365540902984719","article-title":"Treatment results with debridement and retention of infected hip prostheses","volume":"41","author":"Waagsb\u00f8","year":"2009","journal-title":"Scand J Infect Dis"}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201712060-00006","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:41:40Z","timestamp":1787751700000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201712060-00006"}},"subtitle":["Improved Results with Contemporary Management"],"short-title":[],"issued":{"date-parts":[[2017,12,6]]},"references-count":47,"journal-issue":{"issue":"23","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.16.01103","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,6]]}}}