New research advances in the current state of treatment of infected hips

   1. Infection after artificial joint replacement is a catastrophic complication, and most cases of infection eventually require reoperation to remove the prosthesis, with very serious consequences. In recent years, with the improvement of prophylactic antibiotics, laminar flow filtration operating room, antibiotic bone cement and technology, the infection rate has dropped to 1%-2%. However, once the artificial hip arthroplasty is infected, it brings great difficulties to the next step of treatment. If not handled properly, it will leave the patient with lifelong disability.   2. Infected hip includes infection after artificial hip replacement and infection after internal fixation of femoral neck and intertrochanteric fracture and primary infection. Postoperative infection is the most serious complication after artificial joint replacement, and its disastrous consequences not only bring great pain and high medical costs to patients but also become a difficult and bottleneck for joint surgeons.  The diagnosis of post-arthroplasty infection requires a comprehensive consideration of medical history, clinical symptoms, signs and laboratory and some special tests. Nowadays, most scholars believe that joint cavity aspiration is a practical and accurate method to diagnose infection, and bacterial drug sensitivity test can be performed, and the dynamic detection of infection symptoms combined with blood sedimentation and C-reactive protein has been accepted by joint surgeons.  4, in the early development of hip replacement surgery, due to the diagnosis of post-operative hip infection, prognosis and treatment of research gaps, the use of antibiotics alone seems to be the only way, even in the early sensitive antibiotics in high doses of long-term use, its cure rate is still very low, only 23% to 68%. In recent years it has been found that if the infection is caused by Staphylococcus aureus, a combination of rifampicin and β-lactams administered orally for 6 months may be effective. Therefore, the use of antibiotic treatment alone under specific conditions also has a certain role, but should be carefully considered in conjunction with the drug sensitivity of the infecting bacteria and the degree of infection, the period of infection, so as not to miss the time of treatment.  5, with the comprehensive understanding and in-depth study of post-arthroplasty infection, for acute clinical manifestations of less than 2 weeks, a single suspicious Gram-positive bacteria, soft tissue conditions are adequate and the host has immunity. Most scholars believe that stage I arthroplasty can be carefully considered, but the application of antibiotic bone cement and postoperative systemic antibiotics during prosthesis reimplantation should be ensured.  6, at this stage for the treatment of infected hip domestic common use a phase to remove the prosthesis, thorough debridement, removal of infected necrotic tissue, pseudomembrane, dead bone, bone cement. After hydrogen peroxide, metronidazole, saline solution pressure rinsing, the use of antibiotic bone cement 80 grams of curing solution stirring for drawing when manually pinched into shape, the temporary prosthesis inserted into the femoral marrow cavity, the head placed in the acetabulum, regular use of sensitive antibiotics for six weeks. Postoperative bed rest for three to six months is then followed by stage II hip revision surgery. However, due to the poor strength of the temporary prosthesis, the patient could only stand on crutches and could not walk and exercise with weight. Long-term bed rest led to muscle atrophy around the hip joint, soft tissue contracture, acetabular degeneration, osteoporosis, and low Harris function score of the hip joint, which was reported to be only about 30-40 (out of 100). The quality of life is low, and even if the second-stage revision is successful, the results are poor.