Abstract
Background
Failed infected internal fixation produces significant pain and functional disability. In infected internal fixation of hip fractures with partial or complete head destruction, total hip arthroplasty (THA) can be technically challenging; however, it restores hip biomechanics. The present study is to evaluate the results and assess the complications of THA following failed infected internal fixation of these fractures.
Materials and Methods
A retrospective review of prospectively collected data in a tertiary healthcare center was performed of 20 consecutive patients of THA following failed infected internal fixation operated between September 2001 and November 2007. There were 11 dynamic hip screw failures for intertrochanteric fractures, 6 failed osteotomies following transcervical fractures, and 3 failed screw fixations for transcervical fractures.
Results
The average age of the patients was 48.5 years (range 28-70 years) and the average followup period was 6.5 years (range 3.5-10.5 years). An indigenously designed cement spacer was used in a majority of patients (n = 15). The custom-made antibiotic impregnated cement spacer was prepared on-table, with the help of a K-nail bent at 130°, long stem Austin Moore’s prosthesis (n=1), Charnley’s prosthesis (n=1), or bent Rush nail (n=1). The antibiotic mixed cement was coated over the hardware in its doughy phase and appropriately shaped using an asepto syringe or an indigenously prepared spacer template. Nineteen of the 20 patients underwent two-stage revision surgeries. The average Harris hip score improved from 35.3 preoperatively to 82.85 postoperatively at the last followup. A significant difference was found (P <0.0001). None of the patients had recurrence of infection.
Conclusions
The results were comparable to primary arthroplasty in femoral neck fractures. Thus, THA is a useful salvage procedure for failed infected internal fixation of hip fractures.
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References
Hsieh PH, Chang YH, Chen SH, Shih CH. Staged arthroplasty as salvage procedure for deep hip infection following intertrochanteric fracture. Int Orthop 2006;30:228–32.
Partanen J, Syrjälä H, Vähänikkilä H, Jalovaara P. Impact of deep infection after hip fracture surgery on function and mortality. J Hosp Infect 2006;62:44–9.
Duncan CP, Beauchamp C. A temporary antibiotic-loaded joint replacement system for management of complex infections involving the hip. Orthop Clin North Am 1993;24:751–9.
Sharma H, Kakar R. Outcome of Girdlestone’s resection arthroplasty following complications of proximal femoral fractures. Acta Orthop Belg 2006;72:555–9.
Campbell A, Fitzgerald B, Fisher WD, Hamblen DL. Girdlestone pseudarthrosis for failed total hip replacement. J Bone Joint Surg 1978;60:441–2.
Ahlgren SA, Gudmundsson G, Bartholdsson E. Function after removal of a septic total hip prosthesis. A survey of 27 Girdlestone hips. Acta Orthop Scand 1980;51:541–5.
Böhler M, Salzer M. Girdlestone’s modified resection arthroplasty. Orthopedics 1991;14:661–6.
Castellanos J, Flores X, Llusà M, Chiriboga C, Navarro A. The Girdlestone pseudarthrosis in the treatment of infected hip replacements. Int Orthop 1998;22:178–81.
Bittar ES, Petty W. Girdlestone arthroplasty for infected total hip arthroplasty. Clin Orthop 1982;170:83–7.
Clegg J. The results of the pseudarthrosis after removal of an infected total hip prosthesis. J Bone Joint Surg 1977;59:298–301.
Esenwein SA, Robert K, Kollig E, Ambacher T, Kutscha-Lissberg F, Muhr G. Long term results after resection arthroplasty according to Girdle-stone for treatment of persisting infections of the hip joint. Chirurg 2001;72:1336–43.
McElwaine JP, Colville J. Excision arthroplasty for infected total hip replacements. J Bone Joint Surg 1984;66:168–71.
Leunig M, Chosa E, Speck M, Ganz R. A cement spacer for two-stage revision of infected implants of the hip joint. Int Orthop 1998;22:209–14.
Younger AS, Duncan CP, Masri BA. Treatment of infection associated with segmental bone loss in the proximal part of the femur in two stages with use of an antibiotic-loaded interval prosthesis. J Bone Joint Surg Am 1998;80:60–9.
Fink B. Revision of late periprosthetic infections of total hip endoprostheses: pros and cons of different concepts. Int J Med Sci 2009;6:287–95.
Younger AS, Duncan CP, Masri BA, McGraw RW. The outcome of two-stage arthroplasty using a custom-made interval spacer to treat the infected hip. J Arthroplasty 1997;12:615–23.
Lonner JH, Desai P, Dicesare PE, Steiner G, Zuckerman JD. The reliability of analysis of intraoperative frozen sections for identifying active infection during revision hip or knee arthroplasty. J Bone Joint Surg Am 1996;78:1553–8.
Laffosse JM, Molinier F, Tricoire JL, Bonnevialle N, Chiron P, Puget J. Cementless modular hip arthroplasty as a salvage operation for failed internal fixation of trochanteric fractures in elderly patients. Acta Orthop Belg 2007;73:729–36.
Hammad A, Abdel-Aal A, Said HG, Bakr H. Total hip arthroplasty following failure of dynamic hip screw fixation of fractures of the proximal femur. Acta Orthop Belg 2008;74:788–92.
D’Arrigo C, Perugia D, Carcangiu A, Monaco E, Speranza A, Ferretti A. Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthop 2010;34:939–42.
Dean BJ, Matthews JJ, Price A, Stubbs D, Whitwell D, Gibbons CM. Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma. Int Orthop 2012;36:731–4.
Tzurbakis M, Morakis E, Mouzopoulos G, Lasanianos N, Ioannis G. Deep wound infection after a trochanteric fracture internal fixation presenting with hip dislocation: A case report. Cases J 2010;3:19.
Mirra JM, Amstutz HC, Matos M, Gold R. The pathology of the joint tissues and its clinical relevance in prosthesis failure. Clin Orthop Relat Res 1976;117:221–40.
Garvin KL, Hanssen AD. Infection after total hip arthroplasty. Past, present, and future. J Bone Joint Surg Am 1995;77:1576–88.
Zilkens KW, Casser HR, Ohnsorge J. Treatment of an old infection in a total hip replacement with an interim spacer prosthesis. Arch Orthop Trauma Surg 1990;109:94–6.
Ivarsson I, Wahlstrom O, Djerf K, Jacobsson SA. Revision of infected hip replacement. Two-stage procedure with a temporary gentamicin spacer. Acta Orthop Scand 1994;65:7–8.
McDonald DJ, Fitzgerald RH Jr, Ilstrup DM. Two-stage reconstruction of a total hip arthroplasty because of infection. J Bone Joint Surg Am 1989;71:828–34.
Hovelius L, Josefsson G. An alternative method for exchange operation of infected arthroplasty. Acta Orthop Scand 1979;50:93–6.
Nestor BJ, Hanssen AD, Ferrer-Gonzalez R, Fitzgerald RH Jr. The use of porous prostheses in delayed reconstruction of total hip replacements that have failed because of infection. J Bone Joint Surg Am 1994;76:349–59.
Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: A systematic review and meta-analysis. J Bone Joint Surg Am 2010;92:2102–9.
Narayan KK, George T. Functional outcome of fracture neck of femur treated with total hip replacement versus bipolar arthroplasty in a South Asian population. Arch Orthop Trauma Surg 2006;126:545–8.
Patel KK, Ashford RU, Frasquet-Garcia A, Booth C, Joseph SR, De Boer PG. Muller straight stem total hip arthroplasty for fractured neck of femur. Injury 2006;37:727–33.
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Mohanty, S.S., Agashe, M.V., Sheth, B.A. et al. Outcome of total hip arthroplasty as a salvage procedure for failed infected internal fixation of hip fractures. IJOO 47, 87–92 (2013). https://doi.org/10.4103/0019-5413.106921
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DOI: https://doi.org/10.4103/0019-5413.106921