Long Cephalomedullary Nails Can Be a Cheap and Effective Interval Revision Prosthesis in Infected Hip Replacements That Require Proximal Femoral Replacement: A Small Case Series

Boopalan Ramasamy; Aaron Scott Hammat; Renjy Nelson; Stuart Adam Callary; Ping Keung Chan; Lucian Bogdan Solomon

doi:10.1016/j.artd.2023.101218

Long Cephalomedullary Nails Can Be a Cheap and Effective Interval Revision Prosthesis in Infected Hip Replacements That Require Proximal Femoral Replacement: A Small Case Series

Arthroplast Today. 2023 Oct 3:23:101218. doi: 10.1016/j.artd.2023.101218. eCollection 2023 Oct.

Authors

Boopalan Ramasamy^{1

2}, Aaron Scott Hammat², Renjy Nelson^{3

4}, Stuart Adam Callary^{1

2}, Ping Keung Chan⁵, Lucian Bogdan Solomon^{1

2}

Affiliations

¹ Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
² Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.
³ Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
⁴ Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
⁵ Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong.

Abstract

Hip prosthetic joint infection management is complex and expensive, especially in severe bone loss. Reducing the price of interval prosthesis when performing staged revision could minimize costs without compromising outcomes. We present 2 similar techniques developed independently that use an antibiotic-coated cephalomedullary nail with a total hip arthroplasty bearing (head and cemented acetabular component) attached to it as an interval proximal femoral replacement prosthesis. Using this technique, the femoral implant cost was reduced up to 10-fold. All patients have recovered well with resolution of infection and functional recovery similar to patients undergoing proximal femoral replacement. In one case, the lag screw (femoral neck) fractured at 5 months prompting the second-stage revision. This complication should be considered when deciding the timing of second-stage revisions in these cases.

Keywords: Cephallomedullary nail; First stage revision; Gamma nail; Infected arthroplasty; PJI; Temporary spacer.