One-stage revision surgery to treat hip infected nonunion after stabilization with a sliding compression screw

Treatment of post-operative infections following proximal femoral fractures: our institutional experience

Proximal femoral fractures (PFFs) are a major health concern in the elderly population. Improvements made in implants and surgical techniques resulted in faster rehabilitation and shorter length of hospital stay. Despite this, the reduced physiological reserve, associated co-morbidities and polypharmacy intake of the elderly population put them at high risk of postoperative complications particularly of infectious origin. Out of 10061 patients with proximal femoral fractures 105 (1.05%) developed surgical site infection; 76 (72%) infections occurred in patients who had sustained intracapsular (IC) fractures with the remaining 29 (28%) infections occurring in patients with extracapsular (EC) neck of femur fractures. The median number of additional surgical debridements was 2 (range 1-7). MRSA was isolated in 49 (47%) of the cases; 38 patients (36%) ultimately underwent a Girdlestone's excisional arthroplasty. Mortality at 30 days and 3 months was 10% and 31%, respectively. It was noted that post-operative hip infection predisposed to a prolonged length of stay in the acute unit and subsequently to a more dependent destination after discharge.

Staged custom, intramedullary antibiotic spacers for severe segmental bone loss in infected total hip arthroplasty

Introduction. Total hip arthroplasty (THA) infections with severe bone loss pose significant reconstructive challenges. We present our experience with two-stage hip reimplantation using an intramedullary, antibiotic-impregnated nail. Methods. Three patients with infected THA with severe proximal femoral bone loss (Mallory type IIIB or greater) were treated using a custom antibiotic spacer. Clinical outcomes and any complications were recorded. Average followup was 49 months from final reimplantation. Results. Mean age at spacer placement (stage 1) was 53 years. The mean Harris Hip Score at final followup was 80. Two patients had asymptomatic heterotopic ossification, and one patient had a 2 cm leg-length discrepancy. Conclusions. A custom intramedullary nail antibiotic spacer is a reliable option in the staged management of the infected THA with severe proximal femoral bone loss. Benefits of this technique include limb salvage with maintenance of leg length, soft tissue tension, and functional status.

Staged arthroplasty as salvage procedure for deep hip infection following intertrochanteric fracture

Deep hip infection is a rare complication of intertrochanteric fractures and an optimal treatment has not yet been reported. Twenty-seven patients who contracted deep hip sepsis following the failed primary treatment of an intertrochanteric fracture were treated with two-stage hip arthroplasty. Antibiotic-impregnated cement beads were implanted following resection arthroplasty in the first 15 patients, and a temporary cement spacer prosthesis was used in the other 12 hips. There was only one recurrence of infection at an average follow-up of 4.8 years. Complications included non-union of the greater trochanter in four patients, intraoperative femoral fracture in two and fracture of the cement prosthesis in one. The use of an interim spacer was associated with better hip function in the interim period; a decreased operative time and less blood loss at the time of arthroplasty; and a higher hip score at final follow-up. Staged arthroplasty is an effective salvage procedure for deep hip infection after the failed treatment of an intertrochanteric fracture. The use of a temporary spacer maintains hip function between stages, makes arthroplasty less complicated, and improves the clinical outcome.