Abstract
Infection after hip prostheses is a potentially devastating complication, and a serious medical and surgical challenge, especially when associated with Paprosky type III femoral bone loosening. Treatment is difficult and options are limited. We report on a 2-stage revision of 15 patients undergoing femur reconstruction with massive allografts. Materials and methods: This was a prospective study which included 15 patients (10 men and 5 women) with infected hip prosthesis, associated with Paprosky type III femoral proximal massive bone loss. The median age of patients was 64 years with a preoperative functional status score of 6. The average number of procedures to the same hip after the first arthroplasty was 6. All patients benefited from a 2-step surgery with massive allografts and locking prosthesis. The average follow-up time was 36 months. Results: Infection was monomicrobial in 14 cases; and was polymicrobial in 4 cases. Methicillin-resistant Staphylococcus epidermidis was the main bacteria (n = 10). The average C-reactive protein level before the second procedure was 2.3 ± 3.4. It was normalized in 8 cases. We recorded 13 cases of primary consolidation without another surgery, 3 cases of relapse, 2 traumatic dislocations and 2 fractures of the allograft. Conclusion: Hip prosthesis infection is a potentially catastrophic complication with significant negative ramifications for both the patient and the healthcare system. Massive allografts use in Paprosky III femoral defect remains very attractive for bone stock restoration and hip function improvement.
Highlights
Septic loosening poses, besides the major issue of infection, a bone stock restoration problem
We report on 15 cases of femoral reconstruction with massive allografts after a 2-stage revision, following septic hip arthroplasty with proximal femur major bone loss
Microbiology Infection was monomicrobial in 14 cases; and polymicrobial in 4 cases
Summary
Besides the major issue of infection, a bone stock restoration problem. Despite an increase in procedures and primary prevention measures, 0.5% to 2% of primary arthroplasties will be infected. This rate is higher during revision surgery [1] [2]. Infection is a potentially catastrophic and serious complication both individually and in terms of public health. There is a wide agreement in the literature concerning the cost to both the economy and individuals affected by infection. The cost to the US Social Security is estimated at approximately $280 million per year. In Great Britain, the management of infection is estimated at 20,500 50,000 euros per patient [1]-[4]
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