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The patient was derived for urgent endoscopic retrograde cholangiopancreatography, sphincterotomy, removal of prosthesis, washing and placement 10 French prostheses, allowing a favorable evolution of the patient discharged within 72 hours without complications.
The procedures were: needle aspiration (n = 10), incision and drainage (n = 109), debridement (n = 35), joint washout (n = 8), removal of prosthesis (n = 7), thoracotomy/decortication (n = 4), nephrectomy (n = 3), laminectomy (n = 2), chest drain (n = 2), above knee amputation (n = 1), fasciotomy (n = 1), ethmoidectomy (n = 1) and craniectomy with removal of infected bone flap (n = 1).
Treatment for chronic post-operative prosthetic joint infection was undertaken, i.e. removal of prosthesis, soft tissue debridement and spacer.
In total, all six cases required removal of prosthesis for cure including four after failure of medical therapy alone.
Four patients were initially managed without removal of prosthesis, of which three were diagnosed prior to 1984 and one patient diagnosed later initially declined surgical intervention.
In patients with HP, removal of prosthesis or prosthesis components was performed in 11 cases, while in 61 patients the whole prosthesis or parts were exchanged.
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Because of the significant difference in the success of infection control between prosthesis removal and prosthesis preservation observed in the present study, we recommend early removal of prostheses for infection control.
Almost all cases required removal of prostheses and antibiotic therapy based on in vtro sensitivity for an average duration of 5 6 months, with at least 4 6 weeks of parenteral antibiotics [ 5- 8].
The following surgical procedure codes are defined as revision surgery in the NRP: KNFC20-99, "revision with secondary insertion of hip prosthesis"; KNFU1, "removal of hip prosthesis"; KNFG09-29, "other kind of hip arthroplasty"; KNFW69, "revision because of deep infection"; and KNFS19 or KNFS49, "incision and revision because of prosthetic infection".
During the maximum follow-up time of 14 years (median 4.6 years), 597 primary THAs (0.7%) were revised due to infection: 149 (25%) involved total exchange of the prosthesis, 146 (24%) involved partial exchange of the prosthesis, and 302 (50%) involved total removal of the prosthesis.
This was also the case in one of the patients with initial change of inlay who also needed a third intervention (conversion to a Hemi-prosthesis, 27 days later) followed by removal of the prosthesis (172 days after conversion) because of a chronic subluxation with compression of the brachial plexus and denial of the patient to undergo arthrodesis.
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