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. 2019 May 9:10:2151459319847399.
doi: 10.1177/2151459319847399. eCollection 2019.

Management of Severe Proximal Femur Bone Loss With a Modular Articulating Antibiotic Spacer

Wesley Mayes  1 , Paul K Edwards  1 , Simon C Mears  1
Affiliations

Management of Severe Proximal Femur Bone Loss With a Modular Articulating Antibiotic Spacer

Wesley Mayes et al. Geriatr Orthop Surg Rehabil. .

Abstract

Introduction: Management of periprosthetic infection in total hip arthroplasties is challenging, especially when there is severe loss of proximal femoral bone stock. When a 2-stage approach is used, either a static or an articulating spacer may be considered. Static spacers leave the patient with a flail leg, which can be very difficult with massive bone loss. The purpose of this study is to report a novel technique for articulating antibiotic spacers and report our results.

Materials and methods: We describe a technique for an articulating hip spacer in the setting of a large amount of proximal femoral bone loss using a locked intramedullary nail, modular femoral body, and an all-polyethylene constrained acetabular component. This technique allowed for mobilization of the patient without a flail leg. Four patients underwent 2-stage reconstruction, and the case series is reported here.

Results: No complications occurred due to the spacer, and in all cases, a second reconstruction was later carried out after treatment with intravenous antibiotics. Three of 4 patients did well after 2-stage reconstruction, with 1 patient ultimately requiring an amputation.

Discussion: We feel this technique improves upon previously reported large spacers due to the stability and maintenance of leg length.

Conclusion: This technique offers a modular solution to address massive bone loss of the proximal femur in the face of periprosthetic joint infection.

Keywords: articulating spacer; periprosthetic joint infection; proximal femur bone loss; reimplantation; revision hip replacement.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
A, Clinical image demonstrating how the intramedullary nail fits inside the modular proximal body. B, Clinical image demonstrating covering the MAAS entirely with antibiotic loaded cement. MAAS indicates modular articulating antibiotic spacer.
Figure 2.
Figure 2.
Radiographic images of patient 1 presenting radiographs (A&B), interval placement of MAAS (C), and final reconstruction completed using a combination of femoral allograft, intramedullary nail, and bridging lateral locking plate (D).
Figure 3.
Figure 3.
Radiographic images of patient 2 presenting radiographs (A), interval MAAS (B), and final reconstruction completed with a proximal femoral replacement (C). MAAS indicates modular articulating antibiotic spacer.
Figure 4.
Figure 4.
Radiographic images of patient 3 presenting radiographs (A), interval MAAS (B), and final reconstruction done with a diaphyseal fitting modular tapered stem femoral component (C). MAAS indicates modular articulating antibiotic spacer.
Figure 5.
Figure 5.
Radiographic images of patient 4 presenting radiographs (A), interval MAAS (B), and final reconstruction with total femur placement and prophylactic proximal tibia plate (C). MAAS indicates modular articulating antibiotic spacer.
See this image and copyright information in PMC

References

    1. Canham CD, Walsh CP, Incavo SJ. Antibiotic impregnated total femur spacers: a technical tip. Arthroplasty Today. 2018;4(1):65–70. doi:10.1016/j.artd.2017.06.001. - PMC - PubMed
    1. Barrack RL. Rush pin technique for temporary antibiotic-impregnated cement prosthesis for infected total hip arthroplasty. J Arthroplasty. 2002;17(5):600–603. doi:10.1054/arth.2002.32698. - PubMed
    1. Ries MD, Jergesen H. An inexpensive molding method for antibiotic-impregnated cement 208 spacers in infected total hip arthroplasty. J Arthroplasty. 1999;14(6):764–765. doi:10.1016/S0883-5403(99)90234-6. - PubMed
    1. Hofmann AA, Goldberg TD, Tanner AM, Cook TM. Ten-year experience using an articulating antibiotic cement hip spacer for the treatment of chronically infected total hip. J Arthroplasty. 2005;20(7):874–879. doi:10.1016/j.arth.2004.12.055. - PubMed
    1. Ben-Lulu O, Farno A, Gross AE, Backstein DJ, Kosashvili Y, Safir OA. A modified cement spacer technique for infected total hip arthroplasties with significant bone loss. J Arthroplasty. 2012;27(4):613–619. doi:10.1016/j.arth.2011.06.031. - PubMed

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