10. Tsukayama classification of infected hip joint prosthesis

#### 10.1. Introduction

Tsukayama et al. proposed the classification based on the study of 97 patients with infected hip joint prosthesis [11].

11.2. Classification

Class I: Isolated islands of bone.

Class IV: Apparent ankylosis.

11.3. Clinical application

Figure 8. Brooker classification.

HO resection.

11.4. Reliability

(Figure 8).

Class II: Gap between bones at least 1 cm.

Class III: Gap between bones less than 1 cm.

This classification is useful in the follow up of the high-risk patients and in patients with post

Classifications Used in Total Hip Arthroplasty http://dx.doi.org/10.5772/intechopen.77231 31

Vasileiadis et al. from mayo clinic in their study noted a moderate to substantial agreement (k value 0.49–0.71) in the inter observer reliability. Grade IV had best inter observer reliability [13, 14]

#### 10.2. Classification

Positive intraoperative cultures: Two out of five intraoperative specimens positive on culture in a patient undergoing revision hip arthroplasty with no clinical evidence of infection at the time of revision.

Early postoperative infection: Wound infection developed less than 1 month after the operation.

Late chronic infection: Wound infection developed 1 month or more after the index operation and with insidious course.

Acute hematogenous infection: Associated with a documented or suspected antecedent bacteremia and characterized by an acute onset of symptoms in the affected joint with the prosthesis.

#### 10.3. Clinical implication (treatment guidelines)

Positive intraoperative cultures: Intravenous administration of antibiotics for 6 weeks without operative intervention.

Early postoperative infection: Debridement, replacement of the polyethylene inserts of the acetabular component, retention of the prosthesis, and intravenous administration of antibiotics for 4 weeks.

Late chronic infection: Debridement; removal of all prosthetic components and bone cement; and placement of antibiotic beads. Intravenous antibiotics for 6 weeks. Revision arthroplasty 2 weeks after cessation of antibiotic therapy.

Acute hematogenous infection: Debridement, replacement of the polyethylene insert, retention of the prosthesis if it was not loose, and intravenous administration of antibiotics for 6 weeks [11].
