Introduction: Total joint replacement remains a cost effective advance in medical care in terms of alleviating symptoms, maintaining independence, and improving quality of life. While most large series report low infection rates (1-3%), when infection does occur it can consume massive amounts of resources with potentially disastrous outcomes. Early infections less than six months post surgery are much more amenable to treatment, while late infections present a much more difficult challenge with salvage rates ranging from 18-40% reported. The current standard of care is the two step exchange, routinely with six weeks of antibiotics between removal and replacement of the prosthetic joint. In this series, we report on our success in using the vacuum assisted closure technique for treatment of exposed, infected knee and hip joints.

Methods: In this retrospective chart review, a total of 70 (44 hip:26 knee) patients with infected and exposed total joint replacements that were treated with the vacuum assisted closure system were identified. Data analyzed includes: early versus late infection; implant removal; flap closure; and ambulation.

Results: The majority (37 of 44) of infected hip joints were early infections, with 7 late infections. For hips, 27 patients had complete hardware salvage with ambulation (18 original prosthesis and 9 revision prostheses), 10 had complete salvage but were non-ambulatory, 2 had partial salvage with ambulation, 4 had hardware removal (with 1 fusion). One patient had their hardware removed prior to VAC treatment and was successfully revised. The salvage rate for hips was 91%. Two patients required flaps for closure over the hip joint. For knees, the majority were late infections (25/26), with only 1 early infection. Of these 26, 21 were salvaged with ambulation. Of the remaining 5 knee replacements, 2 prostheses were removed, two required amputation, and the last required fusion. Two patients required flaps for closure over the knee joint. The salvage rate for knees was 81%.

Conclusions: The vacuum assisted closure system has proven to be a useful adjunct in the treatment of infected, exposed hip and knee prosthetic joints. The high salvage rate for the knee series (81%) is particularly impressive given that the majority of the infections were late onset. The salvage rate for both hip and knee prostheses with vacuum assisted closure is comparable to the more costly and prolonged two stage exchange.