Combinational Periprosthetic Hip Joint Infection and Fracture: A Two-Stage Revision with Long Femoral Stem Spacers

Periprosthetic joint infection combined with periprosthetic fracture rarely occurs simultaneously. Once all components of the periprosthetic joint infection were removed, antibiotic spacers were placed. Moreover, periprosthetic fractures require fixing. We use a long femoral stem spacer molded intra-operatively via a self-design metal mold as a novel treatment method for the periprosthetic fracture combined with infection.

The study reviewed 12 patients who underwent two-stage revision arthroplasty with long femoral stem spacers over 6 years. During a minimum of two years of follow-up, the outcomes were evaluated, including reinfection rates, reimplantation rates, and re-operation rates, as well as the success rate based on the MSIS criteria.

Twelve patients underwent two-stage revision with a long femoral stem spacer between stages. A mean follow-up period of 9.58 months followed infection (range 2 to 28 months). In 11 patients (91.67%), the infection was eradicated. There was one patient (8.33%) who required a second 2-stage revision and subsequently cleared their infection. The long femoral stem spacer was repeated in three patients (25%). After eradicating the infection, 9 patients (75%) underwent 2nd stage revision, on average 8.56 months after the first stage. At an average of 27.92 months (range 8 - 65 months) post-operatively, three (25%) long femoral stem spacers remained in place.

Using long femoral stem spacers, both periprosthetic joint infections and periprosthetic fractures can be treated simultaneously. In the cases with multiple organisms, we mixed one pack of bone cement with 2g of Vancomycin and 2g of Meropenem, resulting in satisfactory results.