Abstract
BackgroundDespite very good prosthesis retention times, the growing numbers of primary implantations of hip endoprostheses are leading to increasing numbers of revision operations. Periprosthetic infection, particularly in revision implants, often leads to a massive loss of bone stock, so that in a two-stage exchange the only option left is implantation of a megaendoprosthesis. This retrospective study investigated the clinical and functional outcome for patients who received megaendoprostheses in the proximal femur in two-stage exchange procedures.MethodsForty-nine patients were treated between 1996 and 2014 (mean age 71 years, mean follow-up period 52 months). Microorganisms were isolated intraoperatively in 44 patients (89.9%). The reinfection rate was documented in patients who did not undergo any further revision surgery due to mechanical failure (primary) and in patients who had subsequent revisions after reimplantation and subsequent reinfection (secondary).ResultsThe mean C-reactive protein level at the time of reimplantation was 1.25 mg/dL (range 0.5–3.4). The primary success rate with curative treatment for prosthetic joint infection was 92% (four of 49 patients). The secondary success rate with infection revision cases was 82% (three of 17 revision cases). The mean Harris hip score was 69 (range 36–94). The majority of patients needed different types of walking aid or even wheelchairs, and only 50% of the patients were able to walk outside.ConclusionsReinfections occurred in only 8% of patients who underwent two-stage exchanges with a proximal femur replacement. When revision surgery for the proximal femur replacement was required for mechanical reasons, however, the associated reinfections increased the reinfection rate to 18%. Proximal femur replacement achieves a clear reduction in pain, maintenance of leg length, and restoration of limited mobility, and the procedure thus represents a clear alternative to the extensive Girdlestone procedure, which is even more immobilising, or mutilating amputation.
Highlights
Despite very good prosthesis retention times, the growing numbers of primary implantations of hip endoprostheses are leading to increasing numbers of revision operations
Patients and inclusion criteria In a retrospective study, the functional and clinical outcome was analysed in 49 patients who underwent two-stage revision for prosthetic joint infection (PJI) and proximal femur defects
Diagnosis of periprosthetic infections and microorganisms The leading indications for explantation were fistula in 18 cases, bacteria identified on aspirated synovial fluid in 27 cases, intraoperative pus in three cases, and one patient with a positive leukocyte scan in combination with a large osteolysis
Summary
Despite very good prosthesis retention times, the growing numbers of primary implantations of hip endoprostheses are leading to increasing numbers of revision operations. Periprosthetic infection, in revision implants, often leads to a massive loss of bone stock, so that in a two-stage exchange the only option left is implantation of a megaendoprosthesis. This retrospective study investigated the clinical and functional outcome for patients who received megaendoprostheses in the proximal femur in two-stage exchange procedures. As many as 90% of the endoprostheses survive longer than 16 years, but 10% of the patients have to undergo revision surgery due to aseptic loosening, periprosthetic infections, or fractures. The aim of the study was to investigate the functional and clinical outcome after a two-stage procedure for reconstruction with a proximal femur replacement
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