Two-staged exchange arthroplasty with an antibiotic-impregnated PMMA cement spacer in-between two stages has a success rate of 85% to 95% in eradication of infection. Use of vancomycine in high doses has a high potential for complications due to nephrotoxicity.

The aim of this study was to evaluate the results of two-staged exchange arthroplasty in infected hip arthroplasty using low-dose vancomycine-impregnated PMMA cement as an interim spacer between stages.

Thirty-five (20 females, 15 males, average age: 60) patients with a confirmed infected total hip arthroplasty who were treated between 1999 and 2005 were the subjects of the study. In the first stage after removal of the prosthesis and debridement, a spacer made of 40 grams of PMMA cement impregnated with 1 gr vancomycine was placed in the infected joint space. Postoperatively, patients were treated with 6 weeks of intravenous antibiotics in consultation with an infectious disease consultant. When CRP and ESR returned to normal levels, revision surgery with cementless components was performed.

The average follow-up after the second stage was 4 years. The ESR and CRP decreased significantly before the second stage with this treatment protocol (from 81.28 to 17.54 mm/h p< 0.001 and 10.05 to 0.64 mg/dl respectively, p< 0.001). The mean interval between the two stages was 193.3 days. A second debridement was needed in 4 patients (10.8 %) because they did not respond to treatment. Two patients (5.4 %) had recurrent infections after reimplantation and underwent a resection arthroplasty. None of the patients suffered from antibiotic toxicity.

Two-stage exchange arthroplasty using a low dose vancomycine-impregnated cement spacer was an effective method in treating infected hip replacements. With using a lower dose than previously reported, we were able to avoid antibiotic toxicity while effectively treating our patients with the same success rate.

Purpose: Total knee arthroplasty (TKA) is safe and effective in patients with advanced hemophilic arthropathy. This procedure is extremely successful in pain relief and improving functional status, however the limited restoration in motion due to preexisting soft tissue contractures, remains a concern. The purpose of this study is to report the results of TKA in patients with hemophilia using posterior cruciate ligament (PCL) sacrificing prostheses.

Materials and Methods: The records of 18 consequtive hemophilic arthropathy patients who underwent total knee arthroplasty at our institution between 1998 and 2003 were retrospectively reviewed. The patients were evaluated by International Knee Society (IKS) Scoring system with specific attention to range of motion parameters and functional status at preoperative and postoperative clinical evaluation. Postoperative radiologic evaluation was based on the knee Society roent-genographic evaluation and scoring system.

Results: The average age at operation was 34 years (range, 18–60) with an average follow-up of 51 months (range, 12–74). TKA resulted in an improvement in functional and knee scores, and range of motion parameters (p< 0,01). However, the functional status of the patients improved better than the knee status (p < 0,01). No signs of radiographic loosening were seen in any of the components at the final follow-up evaluation. There were two early hemarthrosis which required open lavage. Four patients had late complications. One patient had a periprosthetic fracture, which was treated with open reduction and internal fixation. Another patient had tibial tubercle avulsion and conservative treatment was choosen. One patient had revision secondary to progression of flexion contracture due to repetitive intraarticular hemorrhage, at the third year (26th month). One patient had deep infection.

Conclusions: Our results demonstrate the excellent results in terms of functional scores and to a lesser extent in knee scores. Evaluation of the subcategories of the knee score demonstrated the limited restoration of motion as the reason for lower success rate in knee scores. Although PCL sacrificing designs allow better motion restoration, futher techniques should be developed to release the extraarticular structures that contribute to the flexion contracture, such as hamstring release.