Elsevier

The Journal of Arthroplasty

Volume 28, Issue 2, February 2013, Pages 347-351
The Journal of Arthroplasty

Management of Total Femoral Bone Loss Using a Hybrid Cement Spacer Surgical Technique

https://doi.org/10.1016/j.arth.2012.04.033Get rights and content

Abstract

Standard treatment for an infected total hip arthroplasty is 2-stage revision. Bone loss in infected total hip arthroplasty presents specific challenges during the first stage. This is especially the case when there is massive or complete loss of the femoral bone stock. We describe a technique successfully used in the setting of total femoral bone loss using a hybrid cement spacer. We describe 2 cases illustrating the technique and perioperative course. This technique is a potential solution for total femoral bone loss that allows the individual to maintain mobility before definitive surgery.

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]

References (19)

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    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 Today
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    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 Today
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    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.

The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2012.04.033.

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