Prolonged suppression of infection in total hip arthroplasty.

Nineteen periprosthetic infections after total hip arthroplasty were treated with prolonged suppressive antibiotics without removing the components. In 11, antibiotic therapy was monitored with serum bactericidal titers. Eleven had incision and drainage. Indications included patients' refusal of removal or medical contraindications to surgery. Requirements included well-fixed components, highly sensitive organisms, and no systemic sepsis. The follow-up period averaged 4.1 years after treatment. Nine hips showed no deterioration. Seven prostheses failed, five with progressive hip sepsis. Three patients had increasing symptoms without prosthesis removal. Although two-stage reimplantation is preferred, suppressive antibiotics and prosthesis retention can succeed in some patients and may be considered in old, frail patients with an early infection caused by bacteria responsive to oral antibiotic therapy. Suppressive therapy may also be considered for an otherwise compliant patient who refuses removal of an infected prosthesis. The organism must be sensitive to oral antibiotics, and the patient must be tolerant of the antibiotics.

Osteochondritis dissecans complicating Legg-Perthes disease. A report of four cases.

Osteochondritis dissecans of the femoral head occurs as a rare complication in the late onset of Legg-Perthes disease. The etiology of this complication is uncertain. Theories include: (a) persistence of an ununited fragment and (b) fragmentation of the femoral head weakened by revascularization accompanying healing. The area of osteochondritis dissecans may not be readily apparent on routine radiographs and a high index of suspicion is necessary for diagnosis. Four cases of osteochondritis dissecans of the hip presenting 6--18 years after the diagnosis of Legg-Perthes disease are described. Three patients were studied by arthrography, and the findings correlated well with symptomatology.