Lyophilized xenograft: a case series of histological analysis of biopsies

A Retrospective Observational Cohort Study of Periprosthetic Hip Infection Treated by one-stage Method Including Cases With Bone Graft Reconstruction

Purpose:

Prosthetic joint infection (PJI) is a devastating complication that can affect hip arthroplasty. Its treatment is extremely difficult, and issues regarding the optimal treatment remain unanswered. This study intended to show the effectiveness of the one-stage treatment of PJI.

Materials and Methods:

A retrospective observational cohort study performed from July 2014- August 2018. All patients with suspected PJI were included. Major and minor criteria developed by the International Consensus on Periprosthetic Joint Infection (ICPJI) was used to define infection. Laboratory tests and image exams were performed, and all patients were followed for at least 2 years.

Outcomes:

Success rate (2018 ICPJI definition to success) in treatment of PJI using one-stage revision method. Clinical and functional outcomes defined by Harris Hip Score (HHS).

Results:

Thirty-one patients were screened and 18 analyzed. 69.85 ± 9.76 years was the mean age. Mean follow-up time was 63.84 ± 18.55 months. Ten patients had acetabular defects and required bone graft reconstruction. Sixteen patients were classified as Tier 1, 1 as Tier 3D, and as 1 Tier 3E. Almost 90% of patients submitted to one-stage revision with acetabulum graft reconstruction were free of infection. The overall infection survival rate was 78.31±6.34 months. Candida albicans and sinus tract were statistically significant in univariate Cox’s analysis. The predictor of one-stage revision surgery failure that remained final Cox’s regression model was C. albicans (hazard ratio [HR]: 4.47).

Conclusion:

Treatment through one-stage revision surgery associated with 6 months of antimicrobial is a viable option with acceptable results even when bone graft reconstruction is necessary. C. albicans was a strong predictor of failure in this cohort.

Acetabular revision in total hip arthroplasty with tantalum augmentation and lyophilized bovine xenograft

Objective

To evaluate a mixed technique of acetabular reconstruction, which uses trabecular metal in the form of tantalum augments associated with lyophilized bovine xenograft.

Methods

Fifteen patients were evaluated prospectively, who underwent acetabular reconstruction with impacted lyophilized bovine xenograft associated with the use of tantalum augments. The main outcome was the failure of the tantalum–bone interface.

Results

The population had a mean age of 58.33 years ± 14.27; the majority was female, 80%. Of the total subjects, 66.7% were operated for failure in primary arthroplasty. The mean follow-up time was 45.2 months ± 11.39. The failure rate of the method in the period and population studied was 6.7%.

Conclusion

An extremely high index (93.3%) of success was observed in an average time of 45.2 months of follow-up. Data were comparable to current literature, demonstrating that the technique employed and proposed is adequate for hip reconstruction in young patients.