ABSTRACT
The addition of antibiotic to cement is a frequent practice in aseptic revision hip surgery There is concern about adding vancomycin to cement due to potential effects on mechanical properties and prolonged elution of subtherapeutic levels antibiotic. Bone allografts can store and provide high levels of vancomycin to surrounding tissues. We analyzed the incidence of infection after one-stage aseptic revision hip reconstruction utilizing acetabular and/or femoral vancomycin-impregnated impacted bone allograft and a THA fixed with cement containing no antibiotic. We hypothesized that the infection rate may be similar to that reported in the literature following traditional impaction grafting using antibiotic loaded cement. Seventy five consecutive patients (80 hips) with a preoperative Merle D'Aubigné and Postel functional score averaging 4.8 points were followed up for a mean of 36 months (range 24 - 59 months). The incidence of infection was 1.25% (CI 95%=96.26-100%). A deep infection (thought to be haematognous in origin) occurred in 1 patient 2 years after the index surgery. The average postoperative Merle D´Aubigne score was 16.2 points. The last radiographic evaluation demonstrated a less than 5 mm acetabular migration and a less than 5 mm femoral subsidence in all cases. Vancomycin-supplemented allografts restored bone stock and provided sound fixation with a low incidence of infection. This incidence of deep sepsis is similar to that reported with antibiotic-loaded PMMA but without the reported mechanical and pharmacological disadvantages.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Arthroplasty, Replacement, Hip/methods , Bone Transplantation , Hip Prosthesis , Prosthesis-Related Infections/prevention & control , Vancomycin/administration & dosage , Adult , Aged , Aged, 80 and over , Argentina/epidemiology , Arthroplasty, Replacement, Hip/adverse effects , Bone Cements , Female , Humans , Incidence , Male , Middle Aged , Prosthesis-Related Infections/epidemiology , Recovery of Function , Reoperation , Transplantation, Homologous , Treatment OutcomeABSTRACT
We present the case of a 60-year-old man who had metastasis of a nodular squamous cell carcinoma from a laryngeal carcinoma that mimicked an infected sinus in a 4-month postoperative revision total hip arthroplasty scar. A diagnosis was made at the time of frozen section. The patient died 3 months after tumor resection as a result of multiorgan failure. Nodular squamous cell carcinoma metastasis in a total hip arthroplasty scar is extremely uncommon. However, this association must be considered in a patient with a known tumor after revision surgery. In such patients, we recommend obtaining an intraoperative frozen section to avoid misdiagnosis in cases of infected sinuses associated with implants.
