title: A protocol for staged arthroplasty to salvage infected nonunion of hip fractures.
abstract: BACKGROUND
  Nonunion of hip fractures is not uncommon. Total hip arthroplasty is used to salvage cases of non union or secondary arthritis in these fractures. However, this option may not be available or may be difficult to achieve when infection has superseded the site of nonunion. The objective of this prospective study was to assess if a staged protocol of treatment yields good results in these difficult cases.
  
  
  METHODS
  Twenty-seven consecutive patients who had deep hip infection with failed treatment of hip fractures (intracapsular in 16 cases and extracapsular in 11) were treated between June 2007 and September 2011. Twenty-six completed the planned two-stage hip arthroplasty and one case was lost after the first stage. The average age of the patients was 48.9 years (range 26-74 years) with an average follow up period of 44 months (30-72 months). Analysis was done using the paired t test where P < 0.05 was considered significant.
  
  
  RESULTS
  Infection was controlled in all cases that completed the treatment protocol with no recurrence in all cases at the latest follow up. The Harris hip score of the patients improved significantly from 29 preoperatively to 85 at the latest follow up (P < 0.0001). Two patients had hip dislocation with displacement of the trochanteric fragment while three other patients had fibrous union of the trochanter.
  
  
  CONCLUSIONS
  Staged Arthroplasty procedure to salvage infected non-union of hip fractures is successful in eradicating infection and regaining hip function. Level of evidence IV.
authors.affiliation: Orthopaedic Department, Faculty of Medicine, Menoufia University, Gamal Abdel Nasser Street, Shebin El Kom, Menoufia Governorate, Egypt. aymanebied@gmail.com.
authors.forename: Ayman M
authors.initials: AM
authors.lastname: Ebied
authors.affiliation: Orthopaedic Department, Faculty of Medicine, Menoufia University, Gamal Abdel Nasser Street, Shebin El Kom, Menoufia Governorate, Egypt.
authors.forename: Adel I
authors.initials: AI
authors.lastname: Elseedy
authors.affiliation: Orthopaedic Department, Faculty of Medicine, Menoufia University, Gamal Abdel Nasser Street, Shebin El Kom, Menoufia Governorate, Egypt.
authors.forename: Osama
authors.initials: O
authors.lastname: Gamal
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D002985:Clinical Protocols; D005260:Female; D005599:Fractures, Ununited / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006620:Hip Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic spacer; Failed internal fixation; Hip fracture; Infection; Total hip arthroplasty