Bone grafting and two-stage revision total hip arthroplasty

Periprosthetic deep infection in combination with substantial bone loss is one of the most challenging situations in revision hip surgery. We believe the effective management of these patients requires infection control as well as bone reconstruction. A review of our previously published studies on antibiotic loaded bone allografts is presented in this paper. These investigations provided us with information on the use of bone allografts in combination with antibiotics in cases of previous infection. Our protocol is based on removal of implants, meticulous debridement, parenteral antibiotic therapy and a second-stage reconstruction with vancomycin-supplemented bone allografts to treat an infected hip arthroplasty. We observed that vancomycin does not affect bone allograft incorporation at concentrations that are 300 times higher than the minimum inhibitory concentration for Staphylococcus aureus and Staphylococcus epidermidis. We also obtained adequate pharmacokinetics using these composites, with high local levels without renal impairment. This method has the capacity of acetabular and femoral bone stock restoration, with sound fixation and without increasing the rate of reinfection.