Septic Joint Replacement: An Orthopedic Perspective

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Abstract
Sir—We read with interest the article by Fisman et al. [1] on treatment of infections associated with total hip arthroplasty. At the outset, we commend the authors for tackling this complex and multifaceted topic. Treatment of infections resulting from joint replacement surgery is associated with significant health care costs ($250 million per year in the United States [2]), and improvements in strategies for treatment may help reduce these costs. However, we are concerned that a number of potential limitations of the study were not thoroughly explored, which could alter the study's conclusions. Therefore, the conclusions drawn with regard to the acceptability of debridement and retention as a strategy for treatment of older patients seem premature.