(v) Post-operative infection in total hip arthroplasty

SummaryThe diagnosis of infection starts with a comprehensive history and thorough physical examination. First line investigations should include C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Elevation of one or both of these tests suggests infection and hip aspiration should be undertaken to confirm the diagnosis. Hip aspiration also allows identification of the infecting microorganism. Radionucleotide tests presently have a limited role but may be useful as first line investigations in patients with active inflammatory conditions. If there is still doubt regarding the diagnosis following these investigations then one should use clinical judgment and possibly proceed to intraoperative frozen section. Acute infections can sometimes be successfully treated with retention of the prosthesis but the gold standard treatment for chronic infections is two-stage reimplantation.