Creating a dual articulating antibiotic spacer for management of an infected total femur prosthesis hemiarthroplasty

How to create by your own a customized hip cement mega-spacer for a hip megaprosthesis two-stage revision surgery after oncologic limb-salvage surgery - Surgical technique and case report

Managing chronic periprosthetic infections in patients who have undergone limb-salvage surgery following a malignant bone tumor with megaprosthesis often involves a two-stage revision surgery with the use of a cement-spacer. This paper show details the preparation of a self-made intramedullary metal-stabilized mega-cement spacer for patients needing a two-stage revision surgery due to infection after oncologic bone tumor resection and limb-salvage surgery with megaprosthesis and present two clinical cases treated with this technique. The report provides a practical surgical technique to create a cement hip mega-spacer using readily available tools in most orthopedic surgical settings.

Utilizing a Prefabricated Antibiotic-Impregnated Articular Spacer Combined With an Intramedullary Device for Significant Femoral Bone Loss in Periprosthetic Hip Infection

Periprosthetic joint infection can be a devastating complication following total hip arthroplasty, which often requires a lengthy treatment course that is fraught with complications. There are various types of antibiotic-impregnated spacers that can be used to treat periprosthetic hip infections, with articulating spacers being utilized frequently with the goal of preserving patient range of motion and functionality. Many of these articulating spacers have pre-set sizes and stem options, which accommodate the majority of patients. However, when significant femoral bone loss is evident at the time of revision surgery, many articulating spacer options are not sufficient to provide stability, and custom modifications of available spacer constructs may be needed to fill the bony void. The goal of this article is to report a surgical technique that can be used in the salvage of failed antibiotic-impregnated spacers where severe femoral bone loss is present.

Modular Total Femur Replacement for Staged Total Femur Replacement

As the numbers of arthroplasties performed worldwide increase, so do complications such as prosthetic joint infection. Cases that require a two-stage revision of a total femur replacement in the femur pose an ongoing challenge to the modern orthopedic surgeon. Unlike antibiotic spacers in hip and knee arthroplasty, there lacks a commercially available cement spacer for use in total femur replacements. We describe a novel technique for the intraoperative fabrication of a total femur spacer which uses modular components. As such, our technique is unique as it is modular and, therefore, highly customisable to each individual patient. Individual components can be made by different members of the team simultaneously and then assembled to make the final construct, thereby minimizing operative time. Furthermore, the inherent stability of the spacer allows immediate partial weightbearing and functional rehabilitation while patients are waiting for their second-stage procedure.

Total femur replacement in a patient with chronic persistence osteomyelitis - A case report

INTRODUCTION AND IMPORTANCE

Total femoral replacement (TFR) is a salvage surgical procedure that has been indicated mainly for oncologic indication to avoid lower limb amputation but has recently been indicated for non-oncological disorders.

CASE PRESENTATION

We report the case of a 63-year-old male with chronic osteomyelitis of the left femur, severe pain and bone deformation, the risk of amputation in this patient was very high. The patient underwent total femur replacement (TFR) with a modular mega-prosthesis. TFR was conducted in two phases. The first one consists of femur resection followed by placement of antibiotic cement; and the second operation was performed after 7 weeks, in which a modular mega-prosthesis was implanted. After a 2-month rehabilitation period, the patient recovered basic ambulation without any complaint of pain or detectable residual infection. The 1-year follow-up was uneventful, with no residual pain or infection. The patient retains normal ambulation and daily function.

CLINICAL DISCUSSION

Chronic persistent osteomyelitis is a hard to manage non-neoplastic disorder that leads to amputation in severe cases. In such patients, TFR would be considered as a salvage therapy that could preserve the patient's anatomical integrity and ambulation.

CONCLUSION

To the best of our knowledge, this is the first case of TFR for treatment of chronic persistent osteomyelitis in Vietnam. While TFR are still mainly indicated for oncology patients, TFR is anticipated to be performed more frequently for non-oncological disorders where there are extensive femoral bone loss and risk of amputation.