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

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.