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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 6, 770-775.
doi: 10.1302/0301-620X.87B6.15411  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
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Treatment of deep infection of the hip associated with massive bone loss

TWO-STAGE REVISION WITH AN ANTIBIOTIC-LOADED INTERIM CEMENT PROSTHESIS FOLLOWED BY RECONSTRUCTION WITH ALLOGRAFT

P.-H. Hsieh, MD, Assistant Professor1; C.-H. Shih, MD, Professor2; Y.-H. Chang, MD, Orthopaedic Surgeon1; M. S. Lee, MD, PhD, Associate Professor1; W.-E. Yang, MD, Orthopaedic Surgeon1; and H.-N. Shih, MD, Associate Professor1

1 Department of Orthopaedics, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, 333 Kweishan, Taoyuan, Taiwan.
2 Department of Orthopaedics, Chun Shan Hospital, No. 11, Lane 112, Sec. 4, Jen-Ai Rd, Taipei, Taiwan.

Correspondence should be sent to Dr P.-H. Hsieh; e-mail: hsiehph{at}adm.cgmh.com.tw

We have carried out in 24 patients, a two-stage revision arthroplasty of the hip for infection with massive bone loss. We used a custom-made, antibiotic-loaded cement prosthesis as an interim spacer. Fifteen patients had acetabular deficiencies, eight had segmental femoral bone loss and one had a combined defect.

There was no recurrence of infection at a mean follow-up of 4.2 years (2 to 7). A total of 21 patients remained mobile in the interim period. The mean Merle D’Aubigné and Postel hip score improved from 7.3 points before operation to 13.2 between stages and to 15.8 at the final follow-up. The allograft appeared to have incorporated into the host bone in all patients. Complications included two fractures and one dislocation of the cement prosthesis.

The use of a temporary spacer maintains the function of the joint between stages even when there is extensive loss of bone. Allograft used in revision surgery after septic conditions restores bone stock without the risk of recurrent infection.




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(c) British Editorial Society of Bone and Joint Surgery All Rights Reserved
Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General