The Use of PROSTALAC In Two-stage Reimplantation 0f Septic Total Knee And Hip Arthroplasty

The PROSTALAC (PROSThesis Antibiotic Loaded Acrylic Cement) functional spacer is made with antibiotic-loaded acrylic cement. We use it as an interim spacer in two-stage exchange arthroplasty in cases of infected total knee or total hip replacement. PROSTALAC allows continuous rehabilitation between stages as it maintains good alignment and stability of the joint with a reasonable range of movement. It also helps to maintain the soft-tissue planes, thereby facilitating the second-stage procedure. We report here early outcomes of the use of PROSTALAC in 5 patients - 3 in total knee replacements, 1 in a total hip replacement and 1 in a bipolar hemiarthroplasty.

Advantages of PROSTALAC Prepared by Modified Cement-coating Method / 대한정형외과학회잡지

PURPOSE: To report the clinical advantage and effect of our modified cement-coating method of PROSTALAC for the treatment of infected hip arthroplasty. MATERIALS AND METHODS: Twenty seven patients (mean age, 57), who had been treated with PROSTALAC after an infected hip arthroplasty, were enrolled in this study. Before surgery, the femoral stem was sterilized with gamma-radiation. During the operation, the stem was coated with antibiotics-impregnated cement and introduced into the femoral canal by several repeats of an insertion and removal procedure, just like a piston movement, to fit the stem into the intramedullary canal space. A bipolar hemiarthroplastic polyethylene liner was used for acetabular cup cement-fixation. A periodic hematologic test, such as ESR and CRP, the ability of early ambulation, leg length discrepancy and hip flexion, were checked for the clinical evaluation. RESULTS: CRP was normalized by an average of 4.2 weeks after the PROSTALAC operation. Partial weight bearing was possible 2 weeks after surgery, and mean leg length discrepancy and flexion of hip was 1.4 cm and 63.5degrees, respectively. PROSTALAC was still retained in 5 cases with satisfactory function. Reinfection after final reimplantation (22 cases) was noted in 4 cases (18.2%). Neither dislocation nor periprosthetic fracture occurred after reimplantation. CONCLUSION: The 2 phase treatment with PROSTALAC is an effective method for infected hip arthroplasty. PROSTALAC has considerable benefit for providing daily acting ability before the final reimplantation provided the appropriate surgical technique and strict sterilization of the inserted implements are combined.

Two-stage Revision Surgery of the Infected Hip Bipolar Hemiarthroplasty using the PROSTALAC / 대한정형외과학회잡지

PURPOSE: This study evaluated the clinical and radiological findings as well as the and effectiveness of a two-stage reconstruction using the PROSTALAC for an infected hip bipolar hemiarthroplasty. This reconstruction technique comprises of an initial procedure, the removal of the implant, the insertion of a selfmade PROSTALAC and, a reconstruction with cementless implants. MATERIALS AND METHODS: From November 1996 to October 2001, at our institution, an infection around a hip arthroplasty which had been performed elsewhere in 13 patients (13 infected hips) was treated with a two-stage reconstruction. Postoperatively, all the patients returned for a clinical and radiographic followup at 6 weeks, 3 months, 6 months, and every year after the reconstruction to examine the recurrence of the infection and to determine if there was any loosening of the component. The average follow-up duration was 41.6 months (range, 28 months to 89 months). RESULTS: At the latest follow-up, there were no recurrence of the infection nor was there any loosening of the implants and Harris hip score changed from 52.4 preoperatively, to 84.0 postoperatively. CONCLUSION: A two-stage reconstruction for infected hip arthroplasty with cementless implants showed excellent results, no recurrence of the infection or loosening of the implants, and it is believed that this technique is effective and safe.

Staged Reimplantation using PROSTALAC in Infected Total Hip Arthroplasty: A Case Report / 대한정형외과학회잡지

Despite continually improving results of total hip arthroplasty, infection remains the major debilitating complication. The treatments of infected total hip arthroplasty were variable. but initially we removed infected implants and inserted antibiotic containing cemented spacer so called PRSTALAC to prevent scar contracture and disuse osteoporosis. After 6 weeks later, control of infection was clinically and radiologically determined, we inserted new prosthesis with cement. Three weeks postoperatively, patient began touch down standing exercise. We observed infected total hip patient in whom hip had been salvaged successfuily with twostage implantation using so called "" PROSTALAC "" which was made with Moore stem.