Removal of infected canine cemented total hip prostheses using a femoral window technique.
OBJECTIVE
To evaluate a femoral window technique for retrieval of cemented total hip prostheses.


METHODS
Retrospective clinical study.


METHODS
Twelve dogs with infection of a cemented modular total hip prosthesis.


METHODS
Implant removal was performed by an extended craniolateral approach to the hip and proximal femur without trochanteric osteotomy. The femoral cement mantle was fragmented and removed with simple orthopedic instrumentation by a lateral femoral window that was repaired using cerclage wires. Surgical technique, intraoperative and postoperative complications, bacterial culture results, histopathologic findings, and completeness of cement removal were recorded. Follow-up radiographs were taken 5 to 9 weeks postoperatively. Long-term follow-up information was obtained by client questionnaire. Functional outcome was assessed by scoring ability to stand, sit, walk, run, play, climb stairs, and get into a car.


RESULTS
Prosthesis retrieval was performed 2 to 41 months after implantation (median, 14 months). Complete removal of femoral cement was achieved in 10 dogs. A nondisplaced femoral fissure, extending proximally from the window, was an intraoperative complication in 2 dogs. Staphylococcus spp was most commonly isolated (6 dogs) from interfacial membrane samples. Systemic antibiotic therapy, dependent on susceptibility testing, was administered for 3 to 10 weeks postoperatively. There was radiographic evidence of osteotomy healing at 5- to 9-week reassessment. Recurrence of osteomyelitis was not observed. Long-term functional outcome was considered mildly abnormal.


CONCLUSIONS
The lateral window was an effective technique for retrieval of retained femoral cement.


CONCLUSIONS
Removal of an infected prosthesis using this technique generally resulted in a clinical outcome comparable to that with ab initio femoral head and neck excision.
Dyce
Jonathan
J
Ohio State University College of Veterinary Medicine, Veterinary Teaching Hospital, Columbus, USA.
Olmstead
Marvin L
ML
D000818:Animals; D001843:Bone Cements; D001864:Bone Wires / Q000662:veterinary; D004285:Dogs / Q000601:surgery*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis / Q000009:adverse effects / Q000662:veterinary*; D008297:Male; D010027:Osteotomy / Q000379:methods / Q000662:veterinary*; D016459:Prosthesis-Related Infections / Q000601:surgery / Q000662:veterinary*; D011859:Radiography; D011996:Records / Q000662:veterinary; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000601:surgery / Q000662:veterinary*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014945:Wound Healing
D001843:Bone Cements