The removal of all prosthetic material and a
two-stage revision procedure is the established standard management of
an infected total hip replacement (THR). However, the removal of
well-fixed femoral cement is time-consuming and can result in significant
loss of bone stock and femoral shaft perforation or fracture. We
report our results of two-stage revision THR for treating infection,
with retention of the original well-fixed femoral cement mantle
in 15 patients, who were treated between 1989 and 2002. Following
partial excision arthroplasty, patients received local and systemic
antibiotics and underwent reconstruction and re-implantation at
a second-stage procedure, when the infection had resolved. The mean follow-up of these 15 patients was 82 months (60 to
192). Two patients had positive microbiology at the second stage
and were treated with six weeks of appropriate antibiotics; one
of these developed recurrent infection requiring further revision.
Successful eradication of infection was achieved in the remaining
14 patients. We conclude that when two-stage revision is used for the treatment
of peri-prosthetic infection involving a THR, a well-fixed femoral
cement mantle can be safely left
We prospectively reviewed 14 patients with deficiency of the proximal pole of the scaphoid who were treated by rib osteochondral replacement arthroplasty. Improvement in wrist function occurred in all except one patient with enhanced grip strength, less pain and maintenance of wrist movement. In 13 patients wrist function was rated as good or excellent according to the modified wrist function score of Green and O’Brien. The mean pre-operative score of 54 (35 to 80) rose to 79 (50 to 90) at review at a mean of 64 months (27 to 103). Carpal alignment did not deteriorate in any patient and there were no cases of nonunion or significant complications. This procedure can restore the mechanical integrity of the proximal pole of the scaphoid satisfactorily and maintain wrist movement while avoiding the potential complications of alternative replacement arthroplasty techniques and problems associated with vascularised grafts and salvage techniques.
We describe a patient with cerebral palsy, of normal intelligence, who could not walk but who by the age of 16 had been successfully managed with a staged bilateral total hip arthroplasty using a constrained liner.