Structural allografts for bone stock reconstruction in two-stage revision for infected total hip arthroplasty: good outcome in 16 of 18 patients followed for 5-14 years.
BACKGROUND
The use of massive bone allografts in cases of revision of failed total hip arthroplasties (THAs) due to infection is controversial.


METHODS
18 patients presented with infection at the site of a THA and were treated with a two-stage protocol. In the first stage, the prosthesis was removed together with all necrotic tissues and cement material if present. A custom-made mold of Palacos R cement containing 1 g of gentamicin was then inserted in 17 of the 18 patients. Systemic antibiotics were used during the interval period. In the second stage, the patients had either acetabular or femoral reconstruction using bulk allograft bone.


RESULTS
Mean follow-up was 9 (5-14) years. 1 patient presented with recurrent infection and underwent a Girdlestone resection arthroplasty as definitive treatment. Another patient had a mechanical failure of the acetabular component, which was revised 10 years after the second stage of the reconstruction. The mean Harris Hip Score improved from 34 points preoperatively to 71 points at the last review. By our definition, 16/18 of the patients had a successful outcome.


CONCLUSIONS
Our results support the use of massive allografts in staged reconstructions of infected THAs complicated by considerable bone loss.
Nusem
Iulian
I
Brisbane Private Hospital, Brisbane, Queensland, Australia. iulian_nusem@health.qld.gov.au
Morgan
David A F
DA
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D001843:Bone Cements; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D001843:Bone Cements