Proximal Femoral Allograft in Two-Stage Revision for Failed Septic Hip Arthroplasty

Alidou Traore¹, Karim Tribak², Jeancis Be¹, Maité Van Cauter², Christelle Mobiot-Aka¹, Yaya Sidi Traoré¹, Slim Alban Mbende³, Daouda Kanaté Soumaro¹, Rebecca Eva Boka¹, Jean Cyr Yombi², Christian Delloye², Olivier Cornu²

¹Trauma and Orthopaedic Unit, Yopougon Teaching Hospital, Abidjan, Cote d’Ivoire.
²St-Luc University Clinics (UCL), Brussels, Belgium.
³Neurosurgery Unit, Yopougon Teaching Hospital, Abidjan, Cote d’Ivoire.

DOI: 10.4236/ojo.2015.512051                

Abstract

Infection after hip prostheses is a potentially devastating complication, and a serious medical and surgical challenge, especially when associated with Paprosky type III femoral bone loosening. Treatment is difficult and options are limited. We report on a 2-stage revision of 15 patients undergoing femur reconstruction with massive allografts. Materials and methods: This was a prospective study which included 15 patients (10 men and 5 women) with infected hip prosthesis, associated with Paprosky type III femoral proximal massive bone loss. The median age of patients was 64 years with a preoperative functional status score of 6. The average number of procedures to the same hip after the first arthroplasty was 6. All patients benefited from a 2-step surgery with massive allografts and locking prosthesis. The average follow-up time was 36 months. Results: Infection was monomicrobial in 14 cases; and was polymicrobial in 4 cases. Methicillin-resistant Staphylococcus epidermidis was the main bacteria (n = 10). The average C-reactive protein level before the second procedure was 2.3 ± 3.4. It was normalized in 8 cases. We recorded 13 cases of primary consolidation without another surgery, 3 cases of relapse, 2 traumatic dislocations and 2 fractures of the allograft. Conclusion: Hip prosthesis infection is a potentially catastrophic complication with significant negative ramifications for both the patient and the healthcare system. Massive allografts use in Paprosky III femoral defect remains very attractive for bone stock restoration and hip function improvement.

Keywords

Arthroplasty, Hip, Infection, Femur, Paprosky 3, Massive Allograft

Conflicts of Interest

The authors declare no conflicts of interest.

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