The common recommended treatment for infected
total hip replacement is two-staged exchange including removal of
all components. However, removal of well-fixed femoral stems can
result in structural bone damage. We recently reported on an alternative
treatment of partial two-stage exchange used in selected cases,
in which a well-fixed femoral stem was left and only the acetabular
component removed, the joint space was debrided thoroughly, an antibiotic-laden
polymethylmethacrylate spacer was moulded using a bulb-type syringe
and placed in the acetabulum, intravenous antibiotics were administered
during the interval, and delayed re-implantation was performed.
In 19 patients treated with this technique from January 2000 to
January 2011, 89% were free of infection at a mean follow-up of
four years (2 to 11). Since then, disposable silicone moulds have
become available to fabricate spacers in separate femoral and head
units. The head spacer mould, which incorporates various neck taper adapter
options, greatly facilitates the technique of partial two-stage
exchange. We report our early experience using disposable silicone
head spacer moulds for partial two-stage exchange in seven patients
with infected primary hip replacements. Cite this article:
Antibiotic impregnated articulating spacers are
used in two-stage revision total knee arthroplasty to deliver local antibiotic
therapy while preserving function. We have observed infection control
in greater than 95% of cases with functional outcomes approaching
those seen in revision for aseptic loosening. Higher failure has
been observed with methicillin resistant organisms.
This review is aimed at clinicians appraising
preclinical trauma studies and researchers investigating compromised bone
healing or novel treatments for fractures. It categorises the clinical
scenarios of poor healing of fractures and attempts to match them
with the appropriate animal models in the literature. We performed an extensive literature search of animal models
of long bone fracture repair/nonunion and grouped the resulting
studies according to the clinical scenario they were attempting
to reflect; we then scrutinised them for their reliability and accuracy
in reproducing that clinical scenario. Models for normal fracture repair (primary and secondary), delayed
union, nonunion (atrophic and hypertrophic), segmental defects and
fractures at risk of impaired healing were identified. Their accuracy
in reflecting the clinical scenario ranged greatly and the reliability
of reproducing the scenario ranged from 100% to 40%. It is vital to know the limitations and success of each model
when considering its application.
We report the outcome at ten to 15 years of two-stage revision for hip infection in 99 patients using the Prostalac articulated hip spacer system. All the patients were contacted to determine their current functional and infection status using the Oxford-12, Short form-12, and Western Ontario and McMaster University Osteoarthritis Index questionnaires. A total of 11 of the 99 patients had a further infection, of whom seven responded to repeat surgery with no further sequelae. The mean interval between the stages was five months (1 to 36). We were able to review 48 living patients, with a mean age of 72 years (46 to 86), 34 (71%) of whom provided health-related quality-of-life outcome scores. The mean follow-up was 12 years (10 to 15). The long-term success rate was 89% and with additional surgery this rose to 96%. The mean global Western Ontario and McMaster University Osteoarthritis Index score was 80.6 ( Two-stage revision for hip infection using a Prostalac interim spacer offers a predictable and lasting solution for patients with this difficult problem.
We present a series of 16 patients treated between 1993 and 2006 who had a failed total ankle replacement converted to an arthrodesis using bone grafting with internal fixation. We used tricortical autograft from the iliac crest to preserve the height of the ankle, the malleoli and the subtalar joint. A successful arthrodesis was achieved at a mean of three months (1.5 to 4.5) in all patients except one, with rheumatoid arthritis and severe bone loss, who developed a nonunion and required further fixation with an intramedullary nail at one year after surgery, before obtaining satisfactory fusion. The post-operative American Orthopaedic Foot and Ankle Society score improved to a mean of 70 (41 to 87) with good patient satisfaction. From this series and an extensive review of the literature we have found that rates of fusion after failed total ankle replacement in patients with degenerative arthritis are high. We recommend our method of arthrodesis in this group of patients. A higher rate of nonunion is associated with rheumatoid arthritis which should be treated differently.
