Arthrotomy is considered the standard treatment for septic arthritis of the hip. This may be complicated by AVN or postoperative hip instability. Arthroscopic treatment of this condition is still not an established technique despite its minimally invasive nature and being associated with low morbidity. A three portal arthroscopic technique was used for drainage, debridment and irrigation in 13 patients with septic coxarthrosis. Continuous intraarticular irrigation was not performed, nor was decompression drains used. All patients were treated with intravenous antibiotics for three weeks, followed with oral antibiotics for an additional minimum of three weeks. The patients were followed for 1-7 years. Staphylococcus aureus was identified in four of the six patients. All patients had a rapid postoperative recovery. The mean Harris Hip Score at the last review was 97.5 points. All patients had a full range of motion of the affected hip. No complications occurred with this group of patients. Three directional arthroscopic surgery combined with large volume irrigation is an effective treatment modality in cases of septic arthritis of the hip. It is less invasive than arthrotomy, and offers low post surgical morbidity.
We present our mid-term results with the use of structural allografts in cases of revision of failed THA due to infection. Eighteen patients with a deep infection at the site of a THA were treated with a two-stage revision, which included reconstruction with massive allografts. All the allografts were frozen and sterilised by gamma-irradiation. The mean age at the time of the revision was 65.9 years. A cement spacer containing 1 g of Gentamicin was used during the interval period. Parenteral antibiotics were administrated for a period of three to four weeks. Oral antibiotics were given for an average of 18 weeks. The patients were followed for a mean of 8.9 years (5.4–14.2). Definite deep wound infection developed in one patient (5.6%), who underwent resection arthroplasty. An additional patient underwent re-revision of an acetabular component for mechanical loosening. The mean HHS improved from 34.2 points preoperatively to 70.7 points at the last review. Sixteen of the patients (88.9%) had a successful outcome. Kaplan-Meier survivorship analysis predicted 80.95% rate of survival at 14 years. Radiographicly, all allografts were found to be united to host bone. There were no signs of definite loosening of any of the implants. The complications include one fracture and two postoperative recurrent dislocations. The use of massive allografts in a two-stage reconstruction for infected THA gives satisfactory results and should be considered in cases complicated with severe bone stock loss, where standard revision techniques are not an option.
We have followed a consecutive series of revision hip arthroplasties, performed for severe femoral bone loss using anatomic specific proximal femoral allografts Forty-nine revision hip arthroplasties, using anatomic specific proximal femoral allografts longer than five centimetres were followed for a mean of 10.4 years. The mean preoperative HHS improved from 42.9 points to 76.9 points postoperatively. Six hips (12.2%) were further revised, four for non-union and aseptic failure of the implant (8.2%), one for infection (2%), and one for host step-cut fracture (2%). Junctional union was observed in 44 hips (90%). Three hips underwent re-attachment of the greater trochanter for trochanteric escape (6.1%). Asymptomatic non-union of the greater trochanter was noticed in three hips (6.1%). Moderate allograft resorption was observed in five hips (10.2%). Two fractures of the host step-cut occurred (4.1%). There were four dislocations (8.2%), two of them developed in conjunction with trochanteric escape. By definition of success as increase of HHS by 20 points or more, and no need for any subsequent re-operation related to the allograft and/or the implant, a 75.5% rate of success was found. Kaplan-Meier survivorship analysis predicted 73% rate of survival at 12 years, with the need for further revision of the allograft and/or implant as the end point. We conclude that the good medium-term results with the use of large anatomic- specific femoral allografts justify their continued use in cases of revision hip arthroplasty with severe bone stock loss.
We have followed a consecutive series of forty-nine revision hip arthroplasties (45 patients), performed for severe femoral bone loss using anatomic specific proximal femoral allografts longer than five centimetres. The patients were followed for a mean of 10.4 years, with a five year minimum follow-up. The mean preoperative Harris Hip Score improved from 42.9 points to 76.9 points postoperatively, an average improvement of 33.8 points. Six hips were further revised, for a failure rate of 12.2%, four for non-union and aseptic failure of the implant (8.2%), one for infection (2%), and one for host step-cut fracture (2%). Junctional union was observed in 44 hips (89.8%). Three hips underwent re-attachment of the greater trochanter for trochanteric escape (6.1%). Asymptomatic non-union of the greater trochanter were noticed in three hips (6.1%). Moderate allograft resorption was observed in five hips (10.2%), non were full-thickness graft resorption. Two fractures of the host step-cut occurred (4.1%). There were four dislocations (8.2%), two of them developed in conjunction with trochanteric escape. By definition of success as increase of HHS by 20 points or more, and no need for any subsequent re-operation related to the allograft and/or the implant, a 75.5% rate of success was found. Kaplan-Meier survivorship analysis predicted 73% rate of survival at 12 years, with the need for further revision of the allograft and/or implant as the end point. We conclude that the good medium-term results with the use of large anatomic-specific femoral allografts justify their continued use in cases of revision hip arthroplasty with severe bone stock loss.
Aseptic loosening which may lead to osteolysis and massive loss of bone, remains the major cause of failure after total hip arthroplasty. Reconstruction of acetabular bone stock defects by means of bone grafting is mandatory to create a stable construct to support the cup, recreate anatomy, and restore lower limb length. Numerous classification systems for acetabular bone stock deficiencies have been recommended to date. The one proposed by the American Academy of Orthopedic Surgeons (AAOS) is the most comprehensive and most consistent. This system classifies acetabular defects into segmental (type 1), cavitary (type 2), combined segmental and cavitary (type 3), pelvic dissociation (type 4), and hip fusion (type 5). The aim of this study is to present a long term review of our experience with reconstruction of acetabular bone stock deficiencies in conjugation with revision hip arthroplasties using bone grafting, based on the AAOS classification system. Between 1987 and 1998, 88 revisions using bone grafting to reconstruct acetabular bone stock defects were performed. Of them 4 patients were classified as type 1, 47 as type 2, 29 – type 3, and 8 as type 4. The mean follow-up period was 8 years (range: 2–3 years). The mean Haris Hip Score improved from 35 points preoperatively to 75 postoperatively. All patients improved. The complications included nonunion in 5 cases, joint instability in 6 cases, graft lysis in one case, and neurologic injury in one case. Five cups were considered radiographicaly loose. One case was infected.
