One-stage revision of septic hip prosthesis with antibiotic-loaded bone grafts and cementless implants

Abstract

Infection of total hip replacement (THR) is a serious complication, necessitating its complete removal and thorough debridement of the site. Usually long-term antibiotic treatment and a multitude of surgical interventions within a period of several months are required until a definitive supply can be achieved. One-stage exchange using antibiotic containing cement did not gain widespread use because of several risks, although the possible clinical and economic advantages are evident. Allograft bone may be impregnated with high loads of antibiotics using a special technique and acts as a carrier, avoiding the disadvantages of cement. Based on this technology 37 exchange procedures of infected THR were performed in a single stage, all of them without the use of bone cement. Three hips required re-revision because of re-infection, the remaining 34 hips (92%) stayed infection-free and stable for a period between 2 and 8 years after surgery. No adverse side effects could be found. Incorporation appeared as after grafting with unimpregnated grafts. Antibiotic impregnated allograft bone may enable reconstruction of bone stock, insertion of an uncemented implant and control of infection in a single operation.