JBJI Journal of Bone and Joint Infection JBJI J. Bone Joint Infect. 2206-3552 Ivyspring Göttingen, Germany 10.7150/jbji.24819 Cerclages after Femoral Osteotomy Are at Risk for Bacterial Colonization during Two-Stage Septic Total Hip Arthroplasty Revision Janz Viktor 1 Wassilew Georgi I. 1 Perka Carsten F. 1 Müller Michael 1 Charité - Universitätsmedizin Berlin, Orthopaedic Department, Charitéplatz 1, 10117 Berlin, Germany 06 07 2018 3 3 138 142 Copyright: © 2018 Viktor Janz et al. 2018 This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/ This article is available from https://jbji.copernicus.org/articles/3/138/2018/jbji-3-138-2018.html The full text article is available as a PDF file from https://jbji.copernicus.org/articles/3/138/2018/jbji-3-138-2018.pdf

<p class="p p-first" id="__p2"><strong>Aims:</strong> In cases of a two-stage septic total hip arthroplasty (THA) exchange a femoral osteotomy with subsequent cerclage stabilization may be necessary to remove a well-fixed stem. This study aims to investigate the rate of bacterial colonization and risk of infection persistence associated with <em>in situ</em> cerclage hardware in two-stage septic THA exchange.</p><p id="__p3"><strong>Patients and Methods:</strong> Twenty-three patients undergoing two-stage THA exchange between 2011 and 2016 were included in this retrospective cohort study. During the re-implantation procedure synovial fluid, periprosthetic tissue samples and sonicate fluid cultures (SFC) of the cerclage hardware were acquired.</p><p id="__p4"><strong>Results:</strong> Seven of 23 (30%) cerclage-SFC produced a positive bacterial isolation. Six of the seven positive cerclage-SFC were acquired during THA re-implantation.</p><p id="__p5">Two of the seven patients (29%) with a positive bacterial isolation from the cerclage hardware underwent a THA-revision for septic complications. The other five patients had their THA <em>in situ</em> at last follow-up.</p><p class="p p-last" id="__p6"><strong>Conclusions:</strong> Despite surgical debridement and antimicrobial therapy, a bacterial colonization of cerclage hardware occurs and poses a risk for infection persistence. All cerclage hardware should be removed or exchanged during THA reimplantation.</p>

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