One-stage revision surgery to treat hip infected nonunion after stabilization with a sliding compression screw.

Abstract

Extracapsular hip infected nonunion after stabilization with a sliding hip screw (SCS) is uncommon and a convincing treatment method has not yet been reported in the literature. Thirteen consecutive patients who sustained such a disability were treated with removal of SCS, local radical debridement, vancomycin powder with or without gentamicin solution application, re-insertion of a new SCS, and autogenous cancellous bone grafting. Postoperatively, ambulation with regulated weight bearing was encouraged as early as possible. Infectious microorganisms in 76% (10/13) of the lesion sites were oxacillin-resistant staphylococcus aureus (ORSA). Twelve patients were followed-up for at least 2 years (range, 2~6 years; median, 4 years) and all nonunions healed. The union rate was 100% (12/12) with a median union period of 4 months (range, 3~6 months). No wound infection recurred at the last follow-up. The satisfactory rate of hip function was 92% (11/12, P<0.001). We, therefore, recommend this surgical procedure to treat all patients with a similar disability because of its high success rate and low complication rate.