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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 12, 1580-1584.
doi: 10.1302/0301-620X.90B12.20742  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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One stage uncemented revision of infected total hip replacement using cancellous allograft bone impregnated with antibiotics

H. Winkler, MD, Consultant Orthopaedic Surgeon, Director1; A. Stoiber, MD, Specialist Registrar2; K. Kaudela, MD, Consultant Orthopaedic and Trauma Surgeon2; F. Winter, MD, Specialist Registrar2; and F. Menschik, MD, Consultant Orthopaedic Surgeon, Chairman2

1 Osteitis Center, PrivatklinikDöbling Heiligenstaedterstrasse 57–63, 1190 Vienna, Austria.
2 Orthopaedic Department Weinviertelklinikum Krankenhaus Mistelbach, Liechtensteinstrasse 67, 2130 Mistelbach, Austria.

Correspondence should be sent to Dr H. Winkler; e-mail: h-winkler{at}aon.at

Infection of a total hip replacement (THR) requires component removal and thorough local debridement. Usually, long-term antibiotic treatment in conjunction with a two-stage revision is required. This may take several months. One-stage revision using antibiotic-loaded cement has not gained widespread use, although the clinical and economic advantages are obvious. Allograft bone may be impregnated with high levels of antibiotics, and in revision of infected THR, act as a carrier providing a sustained high local concentration.

We performed 37 one-stage revision of infected THRs, without the use of cement. There were three hips which required further revision because of recurrent infection, the remaining 34 hips (92%) stayed free from infection and stable at a mean follow-up of 4.4 years (2 to 8). No adverse effects were identified. Incorporation of bone graft was comparable with unimpregnated grafts.

Antibiotic-impregnated allograft bone may enable reconstruction of bone stock, insertion of an uncemented implant and control of infection in a single operation in revision THR for infection.




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G. S. Biring, T. Kostamo, D. S. Garbuz, B. A. Masri, and C. P. Duncan
Two-stage revision arthroplasty of the hip for infection using an interim articulated Prostalac hip spacer: A 10- TO 15-YEAR FOLLOW-UP STUDY
J Bone Joint Surg Br, November 1, 2009; 91-B(11): 1431 - 1437.
[Abstract] [Full Text] [PDF]

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One stage uncemented revision of infected total hip replacement
Yuping Liu, et al.
J Bone Joint Surg Br Online, 14 Jan 2009 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General