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Published on: December 3, 2017
Proximal Femoral Replacement for Prosthetic Hip Joint Infection
Sathya Lakpriya1, Lucy Maling1, Gihan Jayasinghe1
1Department of Trauma and Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Kent, GBR.
Introduction:
Revision total hip arthroplasty is a surgical challenge when undertaken for hip prosthetic joint infection (PJI). When PJI occurs in the setting of severe proximal femoral bone loss, proximal femoral replacement (PFR) can serve as an effective salvage strategy, restoring function in prosthetic hips that cannot be reconstructed otherwise.
Materials And Methods:
This retrospective series from a high-volume revision hip surgeon comprises 15 PFRs in 14 patients. Infection was the indication for surgery in all cases. Thirteen patients had confirmed PJI as per the 2018 Musculoskeletal Infection Society (MSIS) criteria. The primary outcome measure was the eradication of infection. Secondary outcome measures included peri- and postoperative complications, re-operation, mobility, and death. The mean follow-up was three years.
Results:
Infection was eradicated in 13 cases (86.6%). Of the two cases with infection, one was asymptomatic for seven years before PJI became evident again. Complications included hip dislocation (three episodes in two patients). One patient underwent revision of the acetabular component due to infected loosening. All but one patient were ambulatory with walking aids. Both patients with persistent or recurrent infection subsequently died.
Conclusions:
PFR is an option for patients with PJI for whom standard revision hip arthroplasty would be unsuitable and excision surgery unacceptable. This study suggests promising results for the eradication of PJI using PFR as a salvage procedure in this particularly challenging cohort.
Level Of Evidence:
The study is classified as level IV evidence.
