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Hip: H. Winkler, A. Stoiber, K. Kaudela, F. Winter, and F. Menschik One stage uncemented revision of infected total hip replacement using cancellous allograft bone impregnated with antibiotics J Bone Joint Surg Br 2008; 90-B: 1580-1584 [Abstract] [Full text] [PDF]

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One stage uncemented revision of infected total hip replacement

Yuping Liu, Guangrong Yu   (14 January 2009)

One stage uncemented revision of infected total hip replacement 14 January 2009
Yuping Liu, Orthopaedics Department of Tongji Hospital Tongji University Shanghai China, Guangrong Yu Send letter to journal: Re: One stage uncemented revision of infected total hip replacement liu9534{at}sohu.com Yuping Liu, et al.	Sir, I read this paper with great interest and agree with the conclusion that one stage revision has many merits to the patients and society for the reasons mentioned, but there are still limitations of the technique. 1. How to do a thorough debridement remains a problem even if saline pulsed lavage is used. There are no strict criteria to follow. The articular cavity cannot be cleaned completely by debridement. 2. Deep cultures taken from joint fluid, soft tissue and bone at the time of debridement lack sensitivity and specificity because of contamination and the very small number of organisms.1 The culture can only be done once. It is difficult to make a correct bacteriological diagnosis. Furthermore, some bacteria may reside in osteoblasts;2 conventional culture usually cannot obtain positive results from the joint fluid, soft tissue and bone. 3. We all know of cases in the early acute stages. There are rarely bony changes on either the acetabular or femoral side. So when these infected hips are revised, allograft bone is not used. Femoral revision usually needs cortical bone allograft which cannot carry much antibiotic. The authors deal with defects on the femoral side with cancellous bone. Thus the early stages of an infected hip with gross femoral bone defects cannot be treated using this technique. 4. The choice of implant was limited. In cases with minor defects a threaded conical acetabular component was used, while larger defects required a hemispherical acetabular component with or without additional screws. We know that revision is more difficult than primary replacement. All these problems cannot be solved with the use of one type of prosthesis, especially on the femoral side. Y. Liu, G. Yu, Orthopaedics Department of Tongji Hospital, Tongji University, Shanghai, China. 1. Trampuz A, Piper KE, Jacobson MJ, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 2007;357:654-63. 2. Ellington JK, Harris M, Hudson MC, et al. Intracellular Staphylococcus aureus and antibiotic resistance: implications for treatment of staphylococcal osteomyelitis. J Orthop Res 2006;24:87-93.