Location
LSU Health Sciences Center - New Orleans
Event Website
https://digitalscholar.lsuhsc.edu/surgery_s/
Document Type
Event
Start Date
4-5-2023 10:00 AM
End Date
4-5-2023 10:10 AM
Description
INTRODUCTION
Although two-stage exchange for prosthetic joint infection (PJI) following total hip arthroplasty (THA) is considered the standard of care in the United States, this treatment poses technical challenges when pelvic discontinuity is present. We present the case of a deep infection associated with pelvic discontinuity successfully treated with a two-stage exchange using an articulating antibiotic spacer.
METHODS
A 37-year-old female with rheumatoid arthritis presented with a periprosthetic right, transverse acetabular fracture and pelvic discontinuity. An acetabular revision using a jumbo cup and posterior column plate was performed without complication. Seven months later, she returned with a large open draining wound. She underwent complete hardware removal and extensive debridement through an extended trochanteric osteotomy. Column fixation was accomplished with a 7-hole pelvic reconstruction plate. A 40mm inner diameter polyethylene liner with a sufficient outer diameter to contact the bone was placed with cement combined with vancomycin 3 g and tobramycin 3.6 g. A femoral stem was cemented in place and the osteotomy was cabled. Wound cultures grew methicillin-sensitive Staphylococcus aureus, and the patient was placed on IV oxacillin. Subsequent recovery (with 8 weeks of IV antibiotics) was unremarkable.
Four months later, after normalization of labs, a revision THA was performed using a cup- cage construct (trabecular metal revision cup size 58 with cage) and a modular tapered revision stem. Intraoperative frozen sections showed a maximum of 5-10 WBC/HPF and cultures were negative.
RESULTS
The patient tolerated the procedure well and can walk without assistance without pain or recurrent infection at 5-year follow-up. Radiographs show no change in implant position or lucent lines.
DISCUSSION and CONCLUSION
This case illustrates a successful two-stage exchange using a plate for the discontinuity and a large, cemented liner for the first stage surgery in a patient with an infected pelvic discontinuity following THA.
Recommended Citation
van Deventer, Leland; Krause, Peter; and Cohen-Rosenblum, Amy, "Treatment of Infected Total Hip Arthroplasty with Pelvic Discontinuity: A Case Report" (2023). Surgery Research Symposium. 11.
https://digitalscholar.lsuhsc.edu/surgery_s/2023/postera/11
Included in
Treatment of Infected Total Hip Arthroplasty with Pelvic Discontinuity: A Case Report
LSU Health Sciences Center - New Orleans
INTRODUCTION
Although two-stage exchange for prosthetic joint infection (PJI) following total hip arthroplasty (THA) is considered the standard of care in the United States, this treatment poses technical challenges when pelvic discontinuity is present. We present the case of a deep infection associated with pelvic discontinuity successfully treated with a two-stage exchange using an articulating antibiotic spacer.
METHODS
A 37-year-old female with rheumatoid arthritis presented with a periprosthetic right, transverse acetabular fracture and pelvic discontinuity. An acetabular revision using a jumbo cup and posterior column plate was performed without complication. Seven months later, she returned with a large open draining wound. She underwent complete hardware removal and extensive debridement through an extended trochanteric osteotomy. Column fixation was accomplished with a 7-hole pelvic reconstruction plate. A 40mm inner diameter polyethylene liner with a sufficient outer diameter to contact the bone was placed with cement combined with vancomycin 3 g and tobramycin 3.6 g. A femoral stem was cemented in place and the osteotomy was cabled. Wound cultures grew methicillin-sensitive Staphylococcus aureus, and the patient was placed on IV oxacillin. Subsequent recovery (with 8 weeks of IV antibiotics) was unremarkable.
Four months later, after normalization of labs, a revision THA was performed using a cup- cage construct (trabecular metal revision cup size 58 with cage) and a modular tapered revision stem. Intraoperative frozen sections showed a maximum of 5-10 WBC/HPF and cultures were negative.
RESULTS
The patient tolerated the procedure well and can walk without assistance without pain or recurrent infection at 5-year follow-up. Radiographs show no change in implant position or lucent lines.
DISCUSSION and CONCLUSION
This case illustrates a successful two-stage exchange using a plate for the discontinuity and a large, cemented liner for the first stage surgery in a patient with an infected pelvic discontinuity following THA.
https://digitalscholar.lsuhsc.edu/surgery_s/2023/postera/11