Management of a Chronically Infected and Unstable Revision Hip Prosthesis with Total Femur Arthroplasty and Antibiotic Cement – Case Report and Review of the Literature Pages 6-11

Jennifer A.J. Mutch1,2 and Ben Benoit1

1Department of Orthopedics, Sacré-Coeur Hospital, Montréal, Québec, Canada; 2University of Montréal, Montréal, Québec, Canada

DOI: http://dx.doi.org/10.12970/2311-9888.2014.02.01.2

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Abstract: Background: Infection, instability, periprosthetic fracture, and severe bone loss are troublesome issues in revision hip arthroplasty. The occurrence of all four together represents a unique therapeutic challenge.

Literature Review: Total femoral arthroplasty is described following tumor resection and in revision arthroplasty with severe bone loss. In these complex cases infection remains a significant concern with rates between 0 and 47% reported. For cases with infection, 2-stage revision procedures have been developed using antibiotic beads or custom total femur antibiotic spacers. However, these techniques involve long periods of non-weight-bearing that may be poorly tolerated in an older population.

Case Presentation: A patient with a chronically infected and dislocating long-stemmed revision hip arthroplasty presented with a severely comminuted distal femur fracture. A 1-stage revision was successfully performed using a modular total femur prosthesis coated with antibiotic cement.

Conclusion: This is the first reported instance of a successful 1-stage revision for infection and severe bone loss using total femur prosthesis. This technique may allow for early mobilization and the avoidance of multiple surgical procedures.

Keywords: Total Femur Arthroplasty, Revision Arthroplasty, Infection, 1-Stage Revision, Hip Arthroplasty. Read more