Infected uncemented hip arthroplasty. Preserving the femoral stem with a two-stage revision procedure

Revision of an infected uncemented hip arthroplasty can be significantly complicated by the presence of extensive bony ingrowth. Although removal of the prosthesis is desirable, technical difficulties in extracting a well anchored prosthesis can be extreme. Femoral windowing or splitting may be necessary. In these cases, treatment alternatives that avoid destruction of the femoral cortex are desirable. A 47-year-old man presented with a deep infection of a virtually fully coated porous implant two years postoperatively. Radiographs revealed extensive bony ingrowth and an arthrogram revealed no dye tracking down the femoral canal. The infecting organism was Staphylococcus epidermis. In order to avoid the possible complications of extraction of this fully coated stem, treatment was carried out initially with removal of the bipolar head, joint debridement, and placement of antibiotic impregnated beads. After seven weeks of intravenous antibiotic therapy with the patient in tibial pin traction, a revision was undertaken and the acetabulum was revised with a threaded uncemented acetabular component. The patient recovered and at 18 month follow-up is without evidence of infection and back to full function. Revision with a two-stage femoral stem preserving procedure is presented as an alternative in the management of infected uncemented hip arthroplasty.