title: Preservation of the original femoral cement mantle during the management of infected cemented total hip replacement by two-stage revision.
abstract: The removal of all prosthetic material and a two-stage revision procedure is the established standard management of an infected total hip replacement (THR). However, the removal of well-fixed femoral cement is time-consuming and can result in significant loss of bone stock and femoral shaft perforation or fracture. We report our results of two-stage revision THR for treating infection, with retention of the original well-fixed femoral cement mantle in 15 patients, who were treated between 1989 and 2002. Following partial excision arthroplasty, patients received local and systemic antibiotics and underwent reconstruction and re-implantation at a second-stage procedure, when the infection had resolved. The mean follow-up of these 15 patients was 82 months (60 to 192). Two patients had positive microbiology at the second stage and were treated with six weeks of appropriate antibiotics; one of these developed recurrent infection requiring further revision. Successful eradication of infection was achieved in the remaining 14 patients. We conclude that when two-stage revision is used for the treatment of peri-prosthetic infection involving a THR, a well-fixed femoral cement mantle can be safely left in situ, without compromising the treatment of infection. Advantages of this technique include a shorter operating time, reduced loss of bone stock and a technically more straightforward second-stage procedure.
authors.affiliation: Department of Orthopaedics, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Morley
authors.forename: S M
authors.initials: SM
authors.lastname: Blake
authors.forename: M J W
authors.initials: MJ
authors.lastname: Hubble
authors.forename: A J
authors.initials: AJ
authors.lastname: Timperley
authors.forename: G A
authors.initials: GA
authors.lastname: Gie
authors.forename: J R
authors.initials: JR
authors.lastname: Howell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D001843:Bone Cements / Q000627:therapeutic use*; D002484:Cementation; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements