Staged Revision of Infected-hip Arthroplasty Using an Antibiotics-loaded Intra-articular Cement Spacer: Impact on Cemented and Cementless Stem Retention / 대한고관절학회지

PURPOSE: Currently, standard management of a peri-prosthetic infection is a two-stage revision precedure. However, removal of well-fixed cement is technically demanding and associated with numerous potential complications. For theses reasons, two-stage revision with preservation of the original femoral stem can be considered and several previous studies have achieved successful results. While most prior studies used cemented stems, the use of cementless stems during arthroplasty has been gradually increasing; this study aims to assess the comparative effectiveness of a two-stage revision of infected hip arthroplasties at preserving cemented and cementless stems.MATERIALS AND METHODS: Between December 2001 and February 2017, Inje University Sanggye Paik Hospital treated 45 cases of deep infections following hip arthroplasty with a two stage revisional arthroplasty using antibiotics-loaded cement spacers. This approach was applied in an effort to preserve the previously implanted femoral stem. Of these 45 cases, 20 were followed-up for at least two years and included in this analysis. Perioperative clinical symptoms, radiological findings, function and complications during insertion of an antibiotics-loaded cement spacer were analyzed in this study.RESULTS: Peri-prothetic infections were controlled in 19 of the 20 included cases. Clinical outcomes, as assessed using the Harris hip score, Western Ontario and McMaster University score, also improved. Importantly, similarly improved outcomes were achieved for both cemented and cementless femoral stems.CONCLUSION: In cases of deep infection following hip arthroplasty, two-stage revision arthroplasty to preserve the previously implanted femoral stem (cemented or cementless) effectively controls infections and preserves joint function.

Staged Revision of Infected Hip Arthroplasty Using an Antibiotics-Loaded Intra-Articular Cement Spacer with Retention of the Stem

PURPOSE: When the femoral stem was well fixed in patients with a deep prosthetic hip infection, the authors performed a two-stage revision procedure using antibiotic-loaded cement spacers (ALCS) without removal of the stem, and the efficacy of this treatment was assessed. MATERIALS AND METHODS: For 12 cases of infected hip arthroplasties, a two-stage procedure was performed, and the patients were followed up for over 2 years. After the acetabular component and head was removed, debridement was done. The molded ALCS was inserted. Revision was then performed after eradication of the infection. The results were analyzed, including the changes in the clinical manifestation, the radiologic findings, the laboratory results, the functional score and the complications. RESULTS: Of all 12 cases, the two-stage revision arthroplasty using an ALCS with retention of the stem was performed in 11 cases (92%), on an average of 66 days (range: 40~152 days). In the 11 revised cases, there was no evidence of recurrence of infection. In the 11 cases, the mean Harris hip score improved from 40.1 points preoperatively to 91.8 points at last the follow-up. The mean WOMAC score improved from 41.8 points preoperatively to 81 points at the last follow-up. The mean Harris hip score was 85.3 points and the WOMAC score was 72.4 points during the ALCS insertion-period. CONCLUSION: For the case of a perioprosthetic hip infection with a well-fixed femoral stem, two-staged revision using an ALCS without stem removal could be an alternative method in terms of effective infection control and preservation of the joint function.

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.