Two stage revision with a proximal femur replacement

Abstract

BackgroundDespite very good prosthesis retention times, the growing numbers of primary implantations of hip endoprostheses are leading to increasing numbers of revision operations. Periprosthetic infection, particularly in revision implants, often leads to a massive loss of bone stock, so that in a two-stage exchange the only option left is implantation of a megaendoprosthesis. This retrospective study investigated the clinical and functional outcome for patients who received megaendoprostheses in the proximal femur in two-stage exchange procedures.MethodsForty-nine patients were treated between 1996 and 2014 (mean age 71 years, mean follow-up period 52 months). Microorganisms were isolated intraoperatively in 44 patients (89.9%). The reinfection rate was documented in patients who did not undergo any further revision surgery due to mechanical failure (primary) and in patients who had subsequent revisions after reimplantation and subsequent reinfection (secondary).ResultsThe mean C-reactive protein level at the time of reimplantation was 1.25 mg/dL (range 0.5–3.4). The primary success rate with curative treatment for prosthetic joint infection was 92% (four of 49 patients). The secondary success rate with infection revision cases was 82% (three of 17 revision cases). The mean Harris hip score was 69 (range 36–94). The majority of patients needed different types of walking aid or even wheelchairs, and only 50% of the patients were able to walk outside.ConclusionsReinfections occurred in only 8% of patients who underwent two-stage exchanges with a proximal femur replacement. When revision surgery for the proximal femur replacement was required for mechanical reasons, however, the associated reinfections increased the reinfection rate to 18%. Proximal femur replacement achieves a clear reduction in pain, maintenance of leg length, and restoration of limited mobility, and the procedure thus represents a clear alternative to the extensive Girdlestone procedure, which is even more immobilising, or mutilating amputation.

Survivorship and clinical outcomes of proximal femoral replacement in non-neoplastic primary and revision total hip arthroplasty: a systematic review

“…Following elimination of duplicate articles, predetermined inclusion and exclusion criteria were applied. In total, 18 articles met the inclusion criteria and were included in the final analysis [ 3 , 4 , 17 – 32 ] (Table 1 ). Consensus on which articles would be analyzed in the present study was achieved by discussion between the reviewers based on the predetermined inclusion and exclusion criteria described above.…”

“…All eighteen studies specified the indication, at time of surgery, for use of the PFR, however three cases were not clearly specified (0.5%) [ 3 , 4 , 17 – 32 ]. Among the studies where details were reported (629 hips), PFRs were most commonly used in revision THA for the treatment of periprosthetic fractures (187 hips, 29.7%), followed by 2-stage revisions with severe bone loss for PJI (184 hips, 29.3%), and aseptic loosening (AL) of previously implanted THA (163 hips, 25.9%).…”

“…Eleven studies (418 of 578 hips, 70.9%) reported the average number of operations before the PFR was performed [ 3 , 4 , 18 , 19 , 23 , 25 , 28 – 32 ], the mean number of procedures was 3.0 (range, 0-22). Type of fixation and implant characteristics are outlined in Table 2 .…”

“…All 18 studies included complications rates [ 3 , 4 , 17 – 32 ]. The overall complication rate was 27.2% (157 of 578 hips).…”

In vitro elution characteristics of gentamicin-impregnated Polymethylmethacrylate: premixed with a second powder vs. liquid Lyophilization

“…The most important benefit of antibiotic-impregnated cement is its ability to provide a high concentration of antibiotics at the local site [11]. Antibiotic-impregnated cement is a treatment option for osteomyelitis and periprosthetic infections [2].…”