Preventing acute infection in total hip prostheses implanted after external fixation of the femur: is there a need for a staged procedure?

We report two cases of acute infection of an uncemented femoral component in a hip prosthesis implanted after external fixation of a femoral fracture. In both cases, the surgical access did not cross over the pin scars. When the prosthesis was implanted the stem crossed one or more pin tracts. The preoperative clinical examination, laboratory tests and bone scintigraphy with marked granulocytosis did not show signs of local infection in either case. We suggest that every patient destined to receive a prosthesis after external fixation should be treated with a staged procedure, the first step being excision of the soft tissues around the pin tracts and curettage or drilling of the bony holes, followed by prosthesis implant.