title: One stage uncemented revision of infected total hip replacement using cancellous allograft bone impregnated with antibiotics.
abstract: Infection of a total hip replacement (THR) requires component removal and thorough local debridement. Usually, long-term antibiotic treatment in conjunction with a two-stage revision is required. This may take several months. One-stage revision using antibiotic-loaded cement has not gained widespread use, although the clinical and economic advantages are obvious. Allograft bone may be impregnated with high levels of antibiotics, and in revision of infected THR, act as a carrier providing a sustained high local concentration. We performed 37 one-stage revision of infected THRs, without the use of cement. There were three hips which required further revision because of recurrent infection, the remaining 34 hips (92%) stayed free from infection and stable at a mean follow-up of 4.4 years (2 to 8). No adverse effects were identified. Incorporation of bone graft was comparable with unimpregnated grafts. Antibiotic-impregnated allograft bone may enable reconstruction of bone stock, insertion of an uncemented implant and control of infection in a single operation in revision THR for infection.
authors.affiliation: Osteitis Center, Döbling, Vienna, Austria. h-winkler@aon.at
authors.forename: H
authors.initials: H
authors.lastname: Winkler
authors.forename: A
authors.initials: A
authors.lastname: Stoiber
authors.forename: K
authors.initials: K
authors.lastname: Kaudela
authors.forename: F
authors.initials: F
authors.lastname: Winter
authors.forename: F
authors.initials: F
authors.lastname: Menschik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001843:Bone Cements; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery; D012086:Reoperation / Q000379:methods; D013203:Staphylococcal Infections / Q000188:drug therapy; D014031:Tobramycin / Q000008:administration & dosage; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D014640:Vancomycin; D014031:Tobramycin