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. 2017 May 31:11:508-516.
doi: 10.2174/1874325001711010508. eCollection 2017.

A Novel Antibiotic Spacer for Significant Proximal Femoral Loss - Surgical Technique

David Shields  1 , Roderick Kong  1 , Sanjay Gupta  1 , Ashish Mahendra  1
Affiliations

A Novel Antibiotic Spacer for Significant Proximal Femoral Loss - Surgical Technique

David Shields et al. Open Orthop J. .

Abstract

Background: Infections of proximal femora with prosthetic implants in situ have long been a major concern in orthopedic surgery. The gold standard in the management of infected proximal femurs in the presence of prosthetic implants has traditionally been a two-stage revision. However, this is challenging in the setting of extensive bone loss.

Methods: A 3 case series of such infections leading to extensive loss of the proximal femur is presented. We specifically describe our technique of debriding the infected segments as well as utilization of a trochanteric slide osteotomy to resect the femur.We also demonstrate preparation of the "pseudoacetabulum" and femoral component with an antibiotic spacer.

Conclusion: The high cost of such a procedure is offset by reduction in time spent in hospital. The spacer also helps to allow mobilization by partial weight bearing on a stable femoral component and provide pain control which improves quality of life as compared to prolonged intravenous antimicrobial therapy.

Keywords: Antibiotics; Bone loss; Femur; Hip; Infection; Revision.

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Figures

Fig. (1)
Fig. (1)
Post resection of prosthesis and debris. Note reamed acetabulum on the left.
Fig. (2)
Fig. (2)
Creation of pseudoacetabulum by compressing a 56mm Austin-Moore into the cement.
Fig. (3)
Fig. (3)
Cement formed around the nail is inserted into the femur.
Fig. (4)
Fig. (4)
Pelvic x-ray showing the retained femoral stem prior to the second revision.
Fig. (5)
Fig. (5)
Postoperative X-rays showing the temporary antibiotic spacer construct. Note the antibiotic cement does not surround the nail within the bone, as opposed to a pre-constructed antibiotic nail.
Fig. (6)
Fig. (6)
CRP trend in the pre and post operative period.
Fig. (7)
Fig. (7)
Definitive reconstruction with proximal femoral replacement and cone pelvis reconstruction.
Fig. (8)
Fig. (8)
X-ray and MRI showing pathological fracture with involvement of proximal femoral diaphysis.
Fig. (9)
Fig. (9)
Proximal femoral replacement as management of the pathological fracture.
Fig. (10)
Fig. (10)
Postoperative x-ray following 1st stage revision.
Fig. (11)
Fig. (11)
X-ray 3 years following 2nd stage revision with no evidence of loosening and signs of bone integration onto the prosthesis.
Fig. (12)
Fig. (12)
Preoperative MRI and postoperative x-ray of the pleomorphic sarcoma reconstructed with a coned pelvis.
Fig. (13)
Fig. (13)
Post operative x-ray of femoral spacer. Note long segment of nail buried into void from previous femoral component stem and preservation of coned pelvis.
See this image and copyright information in PMC

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