Abstract
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.
Résumé
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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References
Callaghan JJ, Katz RP, Johnston RC One-stage revision surgery of the infected hip. A minimum 10-year follow-up study. Clin Orthop 1999;369:139–143
Charlton WPH, Hozack WJ, Teloken MA, Rao R, Bissett GA Complications associated with reimplantation after Girdlestone arthroplasty. Clin Orthop 2003;407:119–126
Duncan CP, Beauchamp C A temporary antibiotic-loaded joint replacement system for management of complex infections involving the hip. Orthop Clin North Am 1993;24:751–759
Engh CA, Massin P, Suthers KE Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop 1990;257:107–128
Haidukewych GJ, Berry DJ Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg (Am) 2003;85(5):899–904
Hardy DC, Descamps PY, Krallis P, Fabeck L, Smets P, Bertens CL, Delince PE Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg (Am) 1998;80(5):618–630
Harris WH Traumatic arthritis of the hip after dislocation and acetabular fractures:Treatment by mold arthroplasty: an end result study using new method of result evaluation. J Bone Joint Surg (Am) 1969;51(4):737–755
Hodgkinson JP, Shelley P, Wroblewski BM The correlation between the roentgenographic appearance and operative findings at the bone-cement junction of the socket in Charnley low friction arthroplasty. Clin Orthop 1988;228:105–109
Hsieh PH, Shih CH, Chang YH, Lee MS, Shih HN, Yang WE Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg (Am) 2004;86(9):1989–1997
Ivarsson I, Wahlstrom O, Dierf K, Jacobson SA Revision of infected hip replacement. Two-stage procedure with a temporary gentamicin spacer. Acta Orthop Scand 1994;65(1):7–8
Jackson WO, Schmalzried TP Limited role of direct exchange arthroplasty in the treatment of infected total hip replacements. Clin Orthop 2000;381:101–105
Magnan B, Regis D, Biscaglia R, Bartolozzi P Preformed acrylic bone cement spacer loaded with antibiotics. Use of two-stage procedure in 10 patients because of infected hips after total replacement. Acta Orthop Scand 2001;72(6):591–594
Merle d’Aubigne R, Postel M Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg (Am) 1954;36:451
Mirra JM, Amstutz HC, Matos M, Gold R The pathology of the joint tissues and its clinical relevance in prosthesis failure. Clin Orthop 1976;117:221–240
Waddell JP, Morton J, Schemitsch EH The role of total hip replacement in intertrochanteric fractures of the femur. Clin Orthop 2004;429:49–53
Watson JT, Moed BR, Cramer KE, Karges DE Comparison of the compression hip screw with the Medoff sliding plate for intertrochanteric fractures. Clin Orthop 1998;348:79–86
Wu CC, Chen WJ One-stage revision surgery to treat hip infected nonunion after stabilization with a sliding compression screw. Arch Orthop Trauma Surg 2003;123(8):383–387
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Hsieh, PH., Chang, YH., Chen, SH. et al. Staged arthroplasty as salvage procedure for deep hip infection following intertrochanteric fracture. International Orthopaedics (SICO 30, 228–232 (2006). https://doi.org/10.1007/s00264-005-0059-6
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DOI: https://doi.org/10.1007/s00264-005-0059-6