Two stage revision with a proximal femur replacement.
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ administration & dosage
Arthroplasty, Replacement, Hip
/ adverse effects
Device Removal
/ adverse effects
Female
Femur
/ surgery
Hip Prosthesis
/ adverse effects
Humans
Male
Middle Aged
Prosthesis Design
Prosthesis-Related Infections
/ etiology
Recurrence
Reoperation
Retrospective Studies
Time Factors
Treatment Outcome
Periprosthetic infection
Proximal femur replacement
Revision arthroplasty
Two stage revision
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
08 Feb 2019
08 Feb 2019
Historique:
received:
18
09
2018
accepted:
30
01
2019
entrez:
10
2
2019
pubmed:
10
2
2019
medline:
29
5
2019
Statut:
epublish
Résumé
Despite very good prosthesis retention times, the growing numbers of primary implantations of hip endoprostheses are leading to increasing numbers of revision operations. Periprosthetic infection, particularly in revision implants, often leads to a massive loss of bone stock, so that in a two-stage exchange the only option left is implantation of a megaendoprosthesis. This retrospective study investigated the clinical and functional outcome for patients who received megaendoprostheses in the proximal femur in two-stage exchange procedures. Forty-nine patients were treated between 1996 and 2014 (mean age 71 years, mean follow-up period 52 months). Microorganisms were isolated intraoperatively in 44 patients (89.9%). The reinfection rate was documented in patients who did not undergo any further revision surgery due to mechanical failure (primary) and in patients who had subsequent revisions after reimplantation and subsequent reinfection (secondary). The mean C-reactive protein level at the time of reimplantation was 1.25 mg/dL (range 0.5-3.4). The primary success rate with curative treatment for prosthetic joint infection was 92% (four of 49 patients). The secondary success rate with infection revision cases was 82% (three of 17 revision cases). The mean Harris hip score was 69 (range 36-94). The majority of patients needed different types of walking aid or even wheelchairs, and only 50% of the patients were able to walk outside. Reinfections occurred in only 8% of patients who underwent two-stage exchanges with a proximal femur replacement. When revision surgery for the proximal femur replacement was required for mechanical reasons, however, the associated reinfections increased the reinfection rate to 18%. Proximal femur replacement achieves a clear reduction in pain, maintenance of leg length, and restoration of limited mobility, and the procedure thus represents a clear alternative to the extensive Girdlestone procedure, which is even more immobilising, or mutilating amputation.
Sections du résumé
BACKGROUND
BACKGROUND
Despite very good prosthesis retention times, the growing numbers of primary implantations of hip endoprostheses are leading to increasing numbers of revision operations. Periprosthetic infection, particularly in revision implants, often leads to a massive loss of bone stock, so that in a two-stage exchange the only option left is implantation of a megaendoprosthesis. This retrospective study investigated the clinical and functional outcome for patients who received megaendoprostheses in the proximal femur in two-stage exchange procedures.
METHODS
METHODS
Forty-nine patients were treated between 1996 and 2014 (mean age 71 years, mean follow-up period 52 months). Microorganisms were isolated intraoperatively in 44 patients (89.9%). The reinfection rate was documented in patients who did not undergo any further revision surgery due to mechanical failure (primary) and in patients who had subsequent revisions after reimplantation and subsequent reinfection (secondary).
RESULTS
RESULTS
The mean C-reactive protein level at the time of reimplantation was 1.25 mg/dL (range 0.5-3.4). The primary success rate with curative treatment for prosthetic joint infection was 92% (four of 49 patients). The secondary success rate with infection revision cases was 82% (three of 17 revision cases). The mean Harris hip score was 69 (range 36-94). The majority of patients needed different types of walking aid or even wheelchairs, and only 50% of the patients were able to walk outside.
CONCLUSIONS
CONCLUSIONS
Reinfections occurred in only 8% of patients who underwent two-stage exchanges with a proximal femur replacement. When revision surgery for the proximal femur replacement was required for mechanical reasons, however, the associated reinfections increased the reinfection rate to 18%. Proximal femur replacement achieves a clear reduction in pain, maintenance of leg length, and restoration of limited mobility, and the procedure thus represents a clear alternative to the extensive Girdlestone procedure, which is even more immobilising, or mutilating amputation.
Identifiants
pubmed: 30736777
doi: 10.1186/s12891-019-2442-2
pii: 10.1186/s12891-019-2442-2
pmc: PMC6368731
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
58Références
Acta Orthop Scand. 1999 Jun;70(3):240-9
pubmed: 10429598
J Bone Joint Surg Br. 2000 Aug;82(6):830-6
pubmed: 10990306
J Arthroplasty. 2001 Aug;16(5):568-74
pubmed: 11503115
Clin Orthop Relat Res. 2003 Dec;(417):224-31
pubmed: 14646721
J Bone Joint Surg Br. 2004 May;86(4):504-9
pubmed: 15174543
Acta Orthop. 2005 Feb;76(1):28-41
pubmed: 15788305
Postgrad Med J. 2006 Feb;82(964):136-9
pubmed: 16461477
Acta Orthop. 2006 Feb;77(1):57-70
pubmed: 16534703
Clin Orthop Relat Res. 2006 Sep;450:164-71
pubmed: 16691142
J Arthroplasty. 2006 Jun;21(4):489-96
pubmed: 16781399
J Bone Joint Surg Am. 2007 May;89(5):1036-43
pubmed: 17473141
Chang Gung Med J. 2007 Jan-Feb;30(1):73-80
pubmed: 17477032
Int J Surg. 2008 Apr;6(2):140-6
pubmed: 18337199
Am J Infect Control. 2008 Jun;36(5):309-32
pubmed: 18538699
Orthop Traumatol Surg Res. 2009 Nov;95(7):491-7
pubmed: 19833568
J Surg Oncol. 2010 Apr 1;101(5):389-95
pubmed: 20119985
Z Orthop Unfall. 2009 Nov-Dec;147(6):694-9
pubmed: 20183746
Clin Orthop Relat Res. 2011 Feb;469(2):470-5
pubmed: 20824405
Acta Orthop Belg. 2010 Aug;76(4):493-502
pubmed: 20973356
Int Orthop. 2012 Apr;36(4):731-4
pubmed: 21826408
Int Orthop. 2012 May;36(5):927-33
pubmed: 21986890
Am J Orthop (Belle Mead NJ). 2011 Dec;40(12):614-5
pubmed: 22268006
Injury. 2012 Jul;43(7):1166-9
pubmed: 22542165
J Arthroplasty. 2014 Feb;29(2):422-7
pubmed: 23856062
J Arthroplasty. 2014 May;29(5):1058-62
pubmed: 24231438
J Arthroplasty. 2014 Nov;29(11):2117-21
pubmed: 25115232
BMC Musculoskelet Disord. 2014 Nov 26;15:398
pubmed: 25428415
Pathol Res Pract. 2014 Dec;210(12):779-86
pubmed: 25454771
J Arthroplasty. 2015 Apr;30(4):681-6
pubmed: 25498955
Z Orthop Unfall. 2017 Feb;155(1):61-66
pubmed: 27632667
Int Orthop. 2017 Jul;41(7):1337-1345
pubmed: 27915374
J Bone Joint Surg Am. 1969 Jun;51(4):737-55
pubmed: 5783851
J Bone Joint Surg Am. 1981 Oct;63(8):1228-39
pubmed: 7287793
J Bone Joint Surg Br. 1995 May;77(3):351-6
pubmed: 7744913
Clin Orthop Relat Res. 1994 Jan;(298):67-74
pubmed: 8118997
Clin Orthop Relat Res. 1996 Jan;(322):207-23
pubmed: 8542698
Acta Orthop Scand. 1996 Feb;67(1):37-42
pubmed: 8615100
Orthop Clin North Am. 1998 Apr;29(2):313-7
pubmed: 9553576