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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_5 | Pages 61 - 61
1 Apr 2018
Takakubo Y Ito J Oki H Momma R Kawaji H Sasaki K Ishii M Takagi M
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Background

The rate of elderly people over 65 year-old increased from 18.5 % in 2004 to 26.0% in 2015 in Japan. Northern part of Japan is a head of the super-aging society, and the rate already reached 30.9% in 2015. Along with aging society, rapid increase of total hip arthroplasties (THA) has been predicted. The aim of this study is to estimate the trend of total hip arthroplasties in our super-aging area in Northern Japan.

Methods

Trend on number and rate of THA in one of the local area of leading super-aging society were surveyed in the last decade using the database of diagnostic procedure and surgical records from 2004 to 2015. The cause of revision THA was analyzed in 2004–2009 versus in 2010–2015. Spearman's rank-correlation coefficient and student's t-tests were performed using the PASW 18 software (SPSS Institute Inc). Values of p < 0.05 were considered statistically significant.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_8 | Pages 48 - 48
1 May 2016
Iizawa N Mori A Majima T Kawaji H Matsui S Takai S
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Precise biomechanical knowledge of individual components of the MCL is critical for proper MCL release during TKA. This study was to define the influences of the deep MCL and the POL on valgus and rotatory stability in TKA using six cadaveric knees with sequential sectioning sequence. A CT-free navigation system monitored motion after application of valgus loads and internal and external rotation torques at 0°, 20°, 30°, 60°, and 90°of knee flexion. Significant increases of rotatory instability were seen on release of the deep MCL. And, rotatory instability further increased after release of the POL. Surgical approach of retaining the deep MCL and POL has a possibility to improve the outcome after primary TKA.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_9 | Pages 23 - 23
1 May 2016
Matsui S Majima T Mominoki K Koizumi R Kawaji H Takahashi K Takai S
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Introduction

Some patients complain ingrown pain or discomfort after implanting Co-Cr conventional endprosthesis of the hip. Some of this complaint may be attributable for effect on cartilage metabolism. It have been reported that ceramic is bioinert for biological tissue. On the other hand, metal including cobalt-chrome (Co-Cr) have some detrimental effect on biological tissue. However, there is no report concerning acetabular cartilage metabolism after hip endprosthesis implantation.

In the present study, we hypothesized that ceramic head have small detrimental effect on cartilage cell metabolism. Specific aim of the study is to compare the protein level of inflammation related cytokines, amount of hyaluronic acid (HA) in culture media, and cartilage mRNA expression in organ culture model of hip end prosthesis implanted using ceramic head and Co-Cr head.

Materials and Methods

Six acetabulum of 3 matured crossbred pig (average weight: 36 +/− 3.6kg) was retrieved. Animal experiment was performed under the rules of ethical committee of animal experiment. Average diameter of pig acetabulum was 26.3 +/− 0.6 mm. Just after sacrifice, mechanical loading using Instron testing machine with 26mm diameter of Co-Cr in right hip and Ceramic heads in left hip was performed in culture media. Ten thousand cycles of cyclic compression and rotation load (1.5kN to 0.15kN of compression and 12 degrees of rotation) to cartilage was applied at 1Hz (Figure 1).

Culture media was analyzed for protein levels of inflammation related cytokines and amount of HA. Relative quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) from acetabular cartilage was performed as previously reported using specific primer sets for type II collagen, aggrecan, TNF-alpha, Interleukine-1 and 6, and MMP-1, 3, 13.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_2 | Pages 95 - 95
1 Jan 2016
Kawaji H Ishii M Tamaki Y Sasaki K Dairaku K Takakubo Y Naganuma Y Oki H Takagi M
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Introduction

Patients undergoing total hip arthroplasty (THA) stand in the danger, a particularly high risk for venous thromboembolism (VTE). Fondaparinux and edoxaban, which inhibit FXa, indirectly and directly, respectively, have been used for prevention of VTE after THA in Japan. The aim of this study was to compare the efficacy of fondaparinux and edoxaban for VTE after elective THA in Japanese patients.

Materials and methods

We randomly assigned 320 patients underdoing elective cemented THA to receive postoperative 2.5 mg fondaparinux once daily for first postoperative 3 days and 1.5 mg once daily for the subsequent 7 days (FPX group) [1], postoperative 15 mg edoxaban once daily for postoperative 10 days (EDO15mg group), 30 mg edoxaban once daily for postoperative 10 days (EDO30mg group), and 30 mg edoxaban once daily for first postoperative 3 days and 15 mg once daily for the subsequent 7 days (EDOmix group). Deep venous thrombosis (DVT) was diagnosed by ultrasonography at postoperative day 3 and 14. Computed tomography to detect pulmonary thromboembolism was performed to all patients who had proximal DVTs. The χ2 test with Bonferroni correction was used to compare variables of the incidence of DVT between each group. The intention-to-treat analysis was performed for statistical analysis in each group. The EDO30 mg group and EDOmix group were regarded as one group in the assessment at the postoperative day 3, and named as the EDO30mg+mix group.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_2 | Pages 63 - 63
1 Jan 2016
Ishii M Takagi M Kawaji H Tamaki Y Sasaki K
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Acetabular reconstruction of extensive bone defect is troublesome in revision total hip arthroplasty (rTHA). Kerboull or Kerboull type reinforcement acetabular device with allobone grafting has been applied since 1996. Clinical results of the procedure were evaluated.

Patients

One hundred and ninety-two consecutive revision total hip arthroplasties were performed with allograft bone supported by the Kerboull or Kerboull type reinforcement acetabular device from 1996 to 2009. There were 23 men and 169 women. Kerboull plates were applied to 18 patients, and Kerboull type plates to 174. The mean follow up of the whole series was 8 years (4–18years).

Surgical Technique

The superior bone defect was reconstructed principally by a large bulky allo block with plate system. Medial bone defect was reconstructed by adequate bone chips and/or sliced bone plates. After temporally fixation of bulky bone block with two 2.0mm K-wires, it was remodeled by reaming to fit the gap between host bone and plate, followed by fixation to the iliac bone by screws. Finally, residual space of the defect between host bone and the fixed plated was filled up with morselized cancellous bones, bone chips, and/or wedged bony fragments with impaction. This method was sufficiently applicable to AAOS Typeâ�, II, and III bone defects. In case of AAOS Typeâ�£, the procedure was also available after repairing discontinuation between distal and proximal bones by reconstrusion plate or allografting with tibial bone plates or sliced femoral head.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_3 | Pages 73 - 73
1 Jan 2016
Naganuma Y Takakubo Y Hirayama T Tamaki Y Oki H Yang S Sasaki K Kawaji H Ishii M Takagi M
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Introduction

Macrophages phagocytes implant wear debris and produce various cytokines to evoke inflammation and periprosthetic osteolysis of aseptic loosening. It had been reported that expression of Toll-like receptor (TLR) 2 and other TLRs increased in periprosthetic tissues of aseptic loosening. Pathogen-associated molecular patterns (PAMPs) and damaged-associated molecular patterns (DAMPs) have been known as ligands of TLRs and considered to be involved in the osteolytic reactions via TLRs. Another type of immune sensors, nucleotide-binding and oligomerization domain (NOD)-like receptors (NLR) with a pyrin domain 3 (NLRP3) can also recognize PAMPs and DAMPs as their lignds, which has been presumed to participate in the local host response of macrophage cascade via phagocytosis of implant wear particles. However, the contribution of NLRP3 in periprosthetic tissues of aseptic loosening and the correlation between TLR2 and NLRP3 are still unclear.

Materials and methods

TLR1, TLR2, TLR6, NLRP3, TNF-α and IL-1β of macrophages in aseptic loose periprosthetic tissues were immnohistorically evaluated and compared to osteoarthritic synovium. RAW264.7 cells, macrophagic cell line, were stimulated by titanium particles (Ti) and lipoteichoic acid (LTA)-coated Ti. The celluar reaction associated with TLR2 and NLRP3 and the correlation of them were analyzed at mRNA expression levels with small-interfering RNA of Irak2, one of adaptor molecules in TLR2 cascades.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_3 | Pages 144 - 144
1 Jan 2016
Sasaki K Ishii M Kawaji H Takakubo Y Tamaki Y Hirayama T Takagi M
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Background and Purpose

Although the treatment for infected total hip arthroplasty (THA) has been still controversial, some reports suggested two-stage revision THA seems to be more preferable rather than one-stage revision. The purpose of this study is to estimate the outcome of treatment for infected THA in our institutions.

Patients and methods

The medical records of patients who have been underwent surgical treatment for infected THA between 2006 and 2012 in two hospitals and followed more than one year after surgery were reviewed. 34 patients and 35 hips were included. Age at surgery, gender, a period until surgical treatment after diagnosis of infection, method of treatment (debridement, one-stage or two-stage revision THA) and the outcome are estimated for each hips. Remission was defined by the absence of local and systemic sign of implant related infection and the normalization of WBC and C-reactive protein value without antibiotics.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_4 | Pages 45 - 45
1 Jan 2016
Takakubo Y Sasaki K Narita A Oki H Naganuma Y Hirayama T Suzuki A Tamaki Y Togashi E Kawaji H Fukushima S Ishii M Takagi M
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Objectives

Biologic agents (BIO) drastically changed the rheumatoid arthritis (RA) therapy from starting to use biologics at 2003 in Japan. The rate of orthopaedic surgery, especially total joint arthroplasty (TJA) may reflect trends in disease severity, management and health outcomes.

Methods

We surveyed the number and rate of orthopaedic surgeries and TJA in RA treatment with BIO in the last decade, so called BIO-era.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_4 | Pages 58 - 58
1 Jan 2016
Tamaki Y Kawaji H Ishii M Dairaku K Takagi M
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INTRODUCTION

Venous thromboembolism (VTE), especially, deep vein thrombosis (DVT) in lower extremities, often seriously combined with pulmonary embolism (PE), is a major and critical complication after total hip arthroplasty (THA). For better disgonsis of VTEs, D-dimer test is one of the useful methods. The aim of this study was to evaluate the efficacy of D-dimer levels before THA.

MATERIALS AND METHODS

Medical records of patients with osteoarthritis who received THA between April 2009 and March 2010 were reviewed. Value of D-dimer at preoperative day 1, postoperative day 3 and 14 was examined in those patients. D-dimer levels were examined by Latex Immunity Nephelometry Measurement Method and the Kit (Sysmex Corporation, Kobe, Japan). A total of 327 patients with D-dimer values were examined. The values D-dimer of the available patients were under 1.0 μg/ml. Ninety-nine patients (30%) had a high D-dimer level. DVT was diagnosed by doppler ultrasonography at preoperative day 1, postoperative day 3 and 14. The sensitivity and specificity of D-dimer in different cutoffs were verified by Receiver Operating Characteristic (ROC) curve. The ROC curve was constructed to describe the relationship between the sensitivity and the false positive rate for different values of D-dimer to patients suspected of VTEs. The study protocol was approved by the institutional ethics committee.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_3 | Pages 147 - 147
1 Jan 2016
Sato A Nakamura H Takahashi K Takenouchi K Kawaji H Takai S
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Purpose

Clinical outocome of revision total elbow arthroplasty(TEA) in rheumatoid arthritis(RA) patients were evaluated.

Methods

Clinical outocome of revision TEA that underwent between 2005 and 2013 were evaluated. Causes of revision, implanted revised prosthesis, a clinical score (the Japanese Orthopaedic Association (JOA) elbow assessment score), the arc of motion and complications were investigated. Totally, 6 patients underwent revision TEA. The patients were females with a mean age of 60.4 years (range, 32 to 72).


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 179 - 179
1 Dec 2013
Takai S Kawaji H Iizawa N
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Introduction:

Although the risk of pulmonary embolism (PE) or other embolic events associated with total joint arthroplasty have been recorded for some time, to date no direct means of these events in human arthroplasty have reported. This prospective study was designed to clarify the pathophysiologic mechanism of PE after total knee arthroplasty (TKA).

Methods:

Nine patients fulfilling the following selection criteria were included in this prospective study: diagnosis of osteoarthosis, age 60 to 75 years, cemented primary TKA. All patients had a baseline pulmonary perfusion scan 2 days prior to the surgery. TKA was performed in the standard manner under general anesthesia. Monitoring of the heart chambers during the course of the TKA was performed using a 5 MHz ultrasonic transducer placed into the esophagus. The 4-chamber view plane of the heart was then imaged using a 2-dimensional echocardiography. A tip of the catheter inserted from the contralateral femoral vein was also placed in the inferior vena cava to harvest the venous blood flowed from the suffered lower extremity before and after tourniquet release. All patients had pulmonary perfusion scans 3 hours after TKA and on the 21st postoperative day. The ventilation-perfusion scan was compared with the baseline perfusion scan.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 178 - 178
1 Dec 2013
Takai S Iizawa N Kawaji H
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Anterior cruciate ligament (ACL) of four major knee ligaments is most crucial ligament to maintain normal knee kinematics. It is well know that ACL dysfunction causes secondary osteoarthritis of the knee. The influence of age on the biomechanical properties of the ACL was examined. The structural properties of 27 pairs of human cadaver knees without OA were evaluated. Specimens were equally divided into three groups of nine pairs each based on age: younger (22 to 35 years), middle (40 to 50 years), and older (60 to 97 years). Tensile tests of the femur-ACL-tibia complex were performed at 30 degrees of knee flexion with the ACL aligned vertically along the direction of applied tensile load. Structural properties of the femur-ACL-tibia complex, as represented by the linear stiffness, ultimate load, and energy absorbed, were found to decrease significantly with specimen age.

On the other hand, little has been written about the arthritic ACL. This study was designed to evaluate the relationship among ROM, cross sections of the intercondylar notch and the macroscopic condition of ACL degeneration. Fifty osteoarthritic patients who underwent TKA as a result of severe osteoarthritis were randomly selected. Occupation rate of the osteophytes to the notch width were measured at the anterior 1/3, middle 1/3, and posterior 1/3 notche images obtained from preoperative tunnel view. ROM was measured preoperatively and under anesthesia. Macroscopic conditions of the ACL and PCL were classified into four types of Normal, Frayed, Partial rupture, and Absent.

The macroscopic ACL conditions were Normal: 12 cases, Frayed: 15 cases, Partial rupture: 14 cases, and Absent: 9 cases. The macroscopic PCL conditions were Normal: 34 cases, Frayed: 9 cases, Partial rupture: 7 cases, and Absent: 0 case. Occupation rate of the osteophytes to the notch correlated to the preoperative varus deformity (p < 0.05). In terms of ACL, the occupation rate of the osteophytes to the notch were 22.9%, 28.8%, 46.0%, and 81.8% in Normal, Frayed, partial ruptured, and Absent, respectively. The patients with more than 40% occupation rate and less than 110 degree of knee flexion angle showed either partial rupture or absent of the ACL during the surgery. Those results correlated with the degree of OA deterioration. We conclude that occupation rate of the osteophytes to the notch poor preoperative ROM is a good predictor of evaluating the ACL degeneration in osteoarthritic knee. We also conclude that ACL dysfunction due to joint space narrowing accelerates the advancement of the knee OA.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 428 - 428
1 Nov 2011
Takagi M Kobayashi S Sasaki K Takakubo Y Kawaji H Tamaki Y Ishii M
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Aim: To ameliorate surgical strategy of disabled rheumatoid hip joints, perioperative status and clinical features of the patients undergoing total hip arthroplasty (THA) were retrospectively evaluated.

Materials and Methods: 150 joints of 106 patients were studied (male/female rate; 1:6, mean age; 60 years and duration of the disease; 15 years). All patients received cemented THA (mean follow-up period; 8 years). Mode of bone defect with acetabular reconstruction type, femoral bone quality, survivorship, steroid use and complications were surveyed.

Results: In preoperative status, proturusio acetabuli was found in 37% with type I; 54%, II; 34% and III; 12% by Sotelo-Garza classification. Superior bone defect was recognized in 56%, collapse and/or defect of femoral head in 19%, and geode formation in 0.2%. Femoral medullar canal was classified as type A; 1%, type B; 53% and type C; 46% by Dorr classification. The presence of fracture before surgery was 5%. Anatomical reconstruction was achieved in all cases including application of 42% bone grafting (autogenous alone; 51%, application of artificial substitute; 39% and of cross-plating system; 10%). Acetabular revision rate due to aseptic loosening (%/years) was improved by graft methods (whole series; 5/8, any grafting; 6/8, autogenous alone; 8/8, artificial substitute; 4/8 and cross-plate system; 0/4). Revision rate for any reasons was 9% (aseptic acetabulum 5%, aseptic femur 5%, dislocation 2% and infection 1%). Dislocation (11%), infection (3%) and severe thrombotic events (1%) were experienced. Steroid use was found in 73%, associated with increased risk of protrusio acetabuli, superior bone defect with protrusio acetabuli and fractures.

Discussion and Conclusion: The study indicated that steroidal medication significantly related to the perioperative status of bone defects and perioperative fractures of rheumatoid patients undergoing THA. Improved ace-tabular procedures could promise better survivorship of the implant.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 112 - 112
1 Mar 2010
Ishii M Kawaji H Dairaku K Hamasaki M Takagi M Kobayashi S Sasaki K
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Revision of the femur component in total hip arthroplasty using impaction bone grafting (IBG) was performed in 140 hips of 136 patients in our hospital. The mean age of the patients at the time of the femoral component revision was 72 years. The median of follow-up time was 80 months. 140 hips were operated with use of YU stem (Yamagata university stem, collared, not polished)104, Exeter stem 2, CPT 2, Restration 5, and others 27.

The length of the stem was a regular stem 114, a long stem 26. The complications related to the revised hip consist of infection 5, dislocation 8, DVT9, fracture during operation 11. Four stems were revised due to infection and two due to loosening.

YU stem is made of titanium alloy with collar, the surface of that stem is not polished and Ra is 0.27 μm. We started to apply IBG in 1994, there were no IBG instrument set and system available such as Exeter, CPT in Japan, so we had used YU stem. However, the result with YU stem was preferable and the implant was stable. Thus, we have been using YU stem. In the process, there have been a number of improvements in IBG instrument and system since we started using them. At first, all medullar cavity is filled with grafted bone up to proximal entry with moderate impaction. Along with guide pin, new medullar canal is made by drilling and insert stem tamper into the space to tighten the layer of impaction, then cement fixation of the stem is performed. This method made the operative time short and operative technique easy.

There are several advantages of IBG technique we used. In revision THA, we can revise the stem with the same length of previous one again and exchange also a long stem to a regular length stem. In addition, the system make it possible to re-construct the case of distal medullar canal excessively filled with bone cement below stem, by digging about around 2 cm distally without need to remove all the cement. Severe bone atrophy and fragile of femur is also reconstructed by IBG.

Impaction bone grafting technique with modified system has great merit to recover bone stock and to obtain implant stability after femoral reconstruction of revision surgery.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 148 - 149
1 Mar 2010
Takagi M Sasaki K Kobayashi S Dairaku K Takakubo Y Ohki H Kawaji H Tamaki Y Ishii M
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Visualization of the femoral medullar canal is troublesome in revision surgery. To obtain better visual field of the canal and assist cement extraction and following reconstructive procedures, flexible endoscope was applied in femoral revision. Mean age and time to revision of fifteen cemented totally replaced hips were 69.3 (42–83) and 14.9 (3–25) years, respectively. Preoperative status of the revision regarding type of stem loosening was classified as possible in four cases, probable in two, and definite in five classified by Harris et al. No marked finding of loosening was in four. That of bone defect was type I in four cases, Type II in three, and Type III in three by Gustilo. Five cases showed no marked loss of the defect. Extraction of cement mantle was performed under flexible endoscopic inspection. Impaction bone grafting was performed in eight cases. Time for cement removal in association with type of loosening and bone defect were evaluated as well as analysis of periprosthetic complications.

Retained cement mantle was extractable in all cases under good exposure and with maintenance of efficient working space. Interfacial granulation and fibrous tissues between bone and cement were easily removed. Endoscopic time for cement removal was 41.7 ± 10.3 minutes in average. It was 51.8 ± 6.2 minutes in no loosening. 41.3 ± 11.1 minutes in possible loosening, 38.5 ± 9.2 minutes in probable loosening, and 35.4 ± 8.3 minutes in definite loosening, which depended on the status of fixation between bone and cement. Type of bone defect also influenced the time. It was 52.4 ± 5.6 minutes in the cases of no marked bone loss, 43.8 ± 3.5 minutes in Gustilo type I, 28.3 ± 3.5 minutes in Type II, and 34.7 ± 2.5 minutes in Type III. The procedure was effective to prepare suitable bone bed for reconstruction, which allowed proper stem settlement and facilitated recovery of bone stock in the cases of impaction bone grafting. Intra-operative blood loss was 377 ml (212 – 1430) and total amount of blood loss including post surgical drainage was 593 ml (316 – 1680). Type of loosening and bone defect did not affect both whole and intra-operative bleeding volume. However, three occult fractures happened, in which two revealed minor cement leakage and one required additional osteosynthesis with extensive approach.

The data indicated that flexible medullo-endoscope could provide good visual field with maintenance of working space, potentially contributing to less invasive femoral revision surgery, if it would be combined with refined device for cement extraction to improve accuracy of the procedure.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 114 - 114
1 Mar 2010
Dairaku K Takagi M Sasaki K Kawaji H Hamasaki M Ishii M
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Infection has been one of the serious complications after total hip arthroplasty. It forces physical and mental stress to the patients. We have routinely applied two-stage revision for infected replaced hip joint. Cement spacer mold technique has been used for the purpose since 2002. The purpose of this study is to analysis of peri-operative status and functional outcome of the patients underwent the two-stage revision procedure.

Nine joints of the eight patients were included in the study. Seven patients were female and one was male and its average age was 64 years (55–81 years). After removal of implant, antibiotic-loaded cement spacer prosthesis which was made by the cement spacer mold (Biomet, Warsaw, USA), was inserted. The leg length, range of motion of the hip, walking ability and complications between first and second-stage operation were analyzed. The change of leg length after first stage operation compared with prior operation was ranged from −18 mm to +13 mm with an average of 20 mm. Average range of hip flexion was 70°(40–90°). Patients could walk with crutches after first-stage operation. Complications after first stage operation were found in two cases; fracture of femoral cement spacer prosthesis and dislocation of the femoral spacer. There was no case of recurrence of infection.

Clinical assessment of two-stage revision for infected replaced hip joint with cement spacer mold showed favorable functional outcome and a few complications after first-stage operation. It also showed satisfactory short-term outcome after second-stage operation.