Preservation of the original femoral cement mantle during the management of infected cemented total hip replacement by two-stage revision

J Bone Joint Surg Br. 2012 Mar;94(3):322-7. doi: 10.1302/0301-620X.94B3.28256.

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.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Arthroplasty, Replacement, Hip / methods*
  • Bacterial Infections / drug therapy
  • Bacterial Infections / microbiology
  • Bacterial Infections / surgery
  • Bone Cements / therapeutic use*
  • Cementation
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Prosthesis Failure
  • Prosthesis-Related Infections / drug therapy
  • Prosthesis-Related Infections / microbiology
  • Prosthesis-Related Infections / surgery*
  • Recurrence
  • Reoperation / adverse effects
  • Reoperation / methods
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Bone Cements