Use of a Cement-Loaded Kuntscher Nail in First-Stage Revision Hip Arthroplasty for Massive Femoral Bone Loss Secondary to Infection: A Report of Four Cases

Abstract

A 2-stage revision total hip replacement (THR) is the standard treatment for a chronically infected THR with severe metadiaphyseal bone loss. A long-stem cemented prosthesis as part of a temporary articular spacer is commonly used during the first-stage procedure. Nonetheless, this option is expensive and can pose difficulties for patients with a small medullary canal. A construct using an antibiotic cement-loaded Kuntscher nail cemented with a highly polished Exeter stem has been devised and used in 4 patients.

Biarticular total femur spacer for massive femoral bone loss: the mobile solution for a big problem

“…The use of articulating spacers for massive femoral bone defects has been described before [3] ( Table 2 ). However, the use of Rush or Kirschner pins is associated to a high pin fracture rate.…”

“…Although there are number of alternatives for preparing these articulating spacers, eg, manually, using silicon/metal molds, commercial spacers, or directly implanting a cemented prosthesis on a temporary basis, very little information is available on the use of such spacers in massive bone defects or defects affecting the entire femur [3] . To our knowledge, there are only 2 reports in the literature on the preparation of femur spacers using a cemented intramedullary nail with a hip stem [3] or PROSTALAC type spacer [4] . In both publications, the knee joint was “sacrificed,” affixing the distal zone of the nail in the proximal tibia.…”

Peri-Prosthetic Joint Infection: Prevention, Diagnosis and Management

“…A cement spacer loaded with antibiotics is used, this is either pre-manufactured or constructed at the time of surgery [160,161]. Various techniques described in the construction of a cement loaded spacer, the technique used depends on the joint involved and the level of bone loss encountered during the first stage [109,[161][162][163][164]. These custom spacers allow antibiotic elution locally to eradicate the infective organism and maintain soft tissue balance to accommodate the definitive implant during the second stage.…”

Management of infection after total hip arthroplasty

“…Richards et al 33 reported good success with a novel technique that uses an antibiotic cement-loaded Küntscher nail cemented with a highly polished femoral stem as a temporary spacer in the setting of massive femoral bone loss. Richards et al 33 reported good success with a novel technique that uses an antibiotic cement-loaded Küntscher nail cemented with a highly polished femoral stem as a temporary spacer in the setting of massive femoral bone loss.…”