Management of Total Femoral Bone Loss Using a Hybrid Cement Spacer Surgical Technique
Section snippets
Surgical Technique
The lateral decubitus position is used with attention given to patient positioning. Sufficient space must be left after bolster placement to allow for an extensile posterior approach to the hip. It is the senior author's preference to use the posterior approach to the hip for both primary and revision hip surgery. The previous scar can be excised at the time of surgery. The incision is extended distally along the lateral aspect of the thigh with deeper dissection in the thigh performed between
Case 1
A 75-year-old woman who had initial primary hip arthroplasty performed for osteoarthritis 16 years previously proceeded to have this revised for aseptic loosening that had been associated with extensive proximal femoral bone loss. A proximal femoral replacement had been used in that revision (Fig. 1). This subsequently became infected, and she was initially treated with antibiotic suppression but with progressive local pain, and swelling was referred to one of our institutions for assessment
Discussion
Deep infection after joint arthroplasty remains a challenge for both patient and surgeon. Internationally, 2-stage revision is the current standard treatment of choice for an infected THA 1, 2, 3, 5, 6, 7, 12, 14, 15, although in some instances, authors offer support for the potential cost effectiveness and benefits of a single-stage revision 16, 17. Excision arthroplasty, Girdlestone procedure, or hip disarticulation may be required when an infected THA is combined with complete bone loss [18]
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Cited by (5)
Modular Total Femur Replacement for Staged Total Femur Replacement
2021, Arthroplasty TodayCitation Excerpt :With the increase in arthroplasty procedures will also come an increase in PJI [9]. Although other techniques have been described in the literature, each has their pros and cons [3-8]. It is, therefore, vital for surgeons to have a range of techniques available to customize their treatment to the specific patient.
Creating a dual articulating antibiotic spacer for management of an infected total femur prosthesis hemiarthroplasty
2019, Arthroplasty TodayCitation Excerpt :This creates a unique surgical challenge for the orthopedic surgeon as little guidance exists on how best to create a spacer in these rare cases. While initial techniques described in the literature demonstrated articulating hip joints with a fixed knee joint [17-20], total knee arthroplasty literature has shown improvements in range of motion (ROM) as well as improved soft-tissue management at the definitive surgery when an articulating spacer is used, which has led toward the favoring of a dual articulating spacer [21,22]. To our knowledge, 3 techniques describing dual articulating total femur spacers have been described to date, with each involving an acetabular cup at the definitive procedure [23-25].
Biarticular total femur spacer for massive femoral bone loss: the mobile solution for a big problem
2018, Arthroplasty TodayCitation Excerpt :The absence of distal bone for affixing the spacer and knee joint implies a great difference between a massive and total bone defect. To our knowledge, only Kamath et al. [4] and Cassar Gheiti et al. [11] have previously described the use of a manual spacer for total femoral defects. Although the authors used different components for preparing an articulating spacer at proximal level (PROSTALAC vs a poly methyl methacrylate-coated stem), both of them inserted a femoral nail at distal level into the tibial endomedullary canal and secured fixation at this level with a lock or simply by applying pressure—sacrificing mobility of the knee joint.
Biarticular total femoral spacer for complete bone loss in periprosthetic joint infection. A technical modification
2019, Revista Espanola de Cirugia Ortopedica y Traumatologia
The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2012.04.033.