title: Treatment of deep infection of the hip associated with massive bone loss: two-stage revision with an antibiotic-loaded interim cement prosthesis followed by reconstruction with allograft.
abstract: We have carried out in 24 patients, a two-stage revision arthroplasty of the hip for infection with massive bone loss. We used a custom-made, antibiotic-loaded cement prosthesis as an interim spacer. Fifteen patients had acetabular deficiencies, eight had segmental femoral bone loss and one had a combined defect. There was no recurrence of infection at a mean follow-up of 4.2 years (2 to 7). A total of 21 patients remained mobile in the interim period. The mean Merle D'Aubigné and Postel hip score improved from 7.3 points before operation to 13.2 between stages and to 15.8 at the final follow-up. The allograft appeared to have incorporated into the host bone in all patients. Complications included two fractures and one dislocation of the cement prosthesis. The use of a temporary spacer maintains the function of the joint between stages even when there is extensive loss of bone. Allograft used in revision surgery after septic conditions restores bone stock without the risk of recurrent infection.
authors.affiliation: Department of Orthopaedics, Chang Gung Memorial Hospital, 333 Kweishan, Taoyuan, Taiwan. hsiehph@adm.cgmh.com.tw
authors.forename: P-H
authors.initials: PH
authors.lastname: Hsieh
authors.forename: C-H
authors.initials: CH
authors.lastname: Shih
authors.forename: Y-H
authors.initials: YH
authors.lastname: Chang
authors.forename: M S
authors.initials: MS
authors.lastname: Lee
authors.forename: W-E
authors.initials: WE
authors.lastname: Yang
authors.forename: H-N
authors.initials: HN
authors.lastname: Shih
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001175:Arthrography; D019644:Arthroplasty, Replacement, Hip; D001843:Bone Cements; D016025:Bone Transplantation; D003131:Combined Modality Therapy; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements