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. 2006 Aug;30(4):228-32.
doi: 10.1007/s00264-005-0059-6. Epub 2006 May 4.

Staged arthroplasty as salvage procedure for deep hip infection following intertrochanteric fracture

Pang-Hsin Hsieh  1 , Yu-Han Chang, Shih-Hao Chen, Chun-Hsiung Shih
Affiliations

Staged arthroplasty as salvage procedure for deep hip infection following intertrochanteric fracture

Pang-Hsin Hsieh et al. Int Orthop. 2006 Aug.

Abstract
in English, French

Deep hip infection is a rare complication of intertrochanteric fractures and an optimal treatment has not yet been reported. Twenty-seven patients who contracted deep hip sepsis following the failed primary treatment of an intertrochanteric fracture were treated with two-stage hip arthroplasty. Antibiotic-impregnated cement beads were implanted following resection arthroplasty in the first 15 patients, and a temporary cement spacer prosthesis was used in the other 12 hips. There was only one recurrence of infection at an average follow-up of 4.8 years. Complications included non-union of the greater trochanter in four patients, intraoperative femoral fracture in two and fracture of the cement prosthesis in one. The use of an interim spacer was associated with better hip function in the interim period; a decreased operative time and less blood loss at the time of arthroplasty; and a higher hip score at final follow-up. Staged arthroplasty is an effective salvage procedure for deep hip infection after the failed treatment of an intertrochanteric fracture. The use of a temporary spacer maintains hip function between stages, makes arthroplasty less complicated, and improves the clinical outcome.

L’infection profonde est une complication rare des fractures intertrochantériennes. Aucun traitement particulier n’a d’ailleurs été rapporté. 27 patients qui ont contracté une infection profonde à la suite d’un échec du traitement initial d’une fracture inter trochantérienne ont été traités par arthroplastie en deux temps. Premièrement, ont été mise en place des billes de ciment imprégné d’antibiotiques après la résection arthroplastique chez les 15 premiers patients. Un spacer temporaire de ciment a été utilisé pour les 12 autres hanches. Il y a eu une seule récidive d’infection avec un délai 4,8 ans. Les complications sont les suivantes, pseudarthrose du grand trochanter chez 4 patients, fracture per-opératoire du fémur chez 2 patients, fracture du spacer en ciment chez un patient. L’utilisation d’un spacer temporaire est bien corrélée avec une bonne fonction de la hanche pendant la période d’implantation temporaire. Cette période d’implantation permet une diminution du temps opératoire, de reprise, une moindre perte sanguine durant l’arthroplastie et un meilleur score final après l’implantation. La réalisation d’une arthroplastie en deux temps pour un échec de traitement de fracture inter trochantérienne donne un résultat satisfaisant, l’utilisation d’un spacer temporaire maintient une bonne fonction de la hanche entre les deux temps opératoires et permet la réalisation d’une arthroplastie avec moins de complications et un meilleur résultat à long terme.

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Figures

Fig 1
Fig 1
a The metal mold used to make the cement prosthesis; b the femoral component of the cement prosthesis
Fig 2
Fig 2
a An AP radiograph of an 81-year-old man with septic nonunion of an intertrochanteric fracture shows cutout of a hip screw and loosening of the side plate with broken screws. b A radiograph shows the hip 4 months after the first-stage surgery. An antibiotic-loaded cement prosthesis was used to maintain leg length and hip function. c A radiograph 2 years after total hip arthroplasty shows stable uncemented components
See this image and copyright information in PMC

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