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Two stage revision with a proximal femur replacement
Ralf Dieckmann1, Tom Schmidt-Braekling2, Georg Gosheger2
1Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany. Ralf.Dieckmann@ukmuenster.de.
BMC Musculoskeletal Disorders
|February 10, 2019
Summary
Two-stage exchange with proximal femur replacement effectively treats hip infections, achieving a 92% success rate. This procedure reduces pain and restores mobility, offering a vital alternative to more invasive surgeries.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Management
- Biomedical Engineering
Background:
- Increasing primary hip replacements lead to more revision surgeries.
- Periprosthetic infections in revisions cause significant bone loss, necessitating megaendoprostheses.
- Two-stage exchange procedures are often required for complex cases.
Purpose of the Study:
- To evaluate the clinical and functional outcomes of proximal femur megaendoprostheses in two-stage exchange procedures.
- To assess the reinfection rates associated with this surgical approach.
- To compare the effectiveness of proximal femur replacement against other surgical options.
Main Methods:
- Retrospective study of 49 patients (mean age 71) between 1996-2014.
- Intraoperative microorganism isolation in 89.9% of cases.
- Documentation of primary and secondary reinfection rates.
Main Results:
- Primary success rate for prosthetic joint infection was 92%.
- Secondary success rate for infection revisions was 82%.
- Mean Harris hip score was 69; 50% of patients could walk outdoors with aids.
Conclusions:
- Proximal femur replacement in two-stage exchanges has a low reinfection rate (8%).
- Mechanical complications increased reinfection to 18%.
- This procedure offers pain reduction, leg length maintenance, and improved mobility, serving as an alternative to Girdlestone or amputation.
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