A Novel Antibiotic Spacer for Significant Proximal Femoral Loss - Surgical Technique



David Shields, Roderick Kong*, Sanjay Gupta, Ashish Mahendra
Department of Musculoskeletal Oncology, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0ET Scotland, United Kingdom


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© 2017 Shields et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Musculoskeletal Oncology, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0ET Scotland, United Kingdom; Tel: 416 939 3236; E-mail: sanjaygupta@doctors.org.uk


Abstract

Background:

Infections of proximal femora with prosthetic implants in situ have long been a major concern in orthopedic surgery. The gold standard in the management of infected proximal femurs in the presence of prosthetic implants has traditionally been a two-stage revision. However, this is challenging in the setting of extensive bone loss.

Methods:

A 3 case series of such infections leading to extensive loss of the proximal femur is presented. We specifically describe our technique of debriding the infected segments as well as utilization of a trochanteric slide osteotomy to resect the femur.We also demonstrate preparation of the “pseudoacetabulum” and femoral component with an antibiotic spacer.

Conclusion:

The high cost of such a procedure is offset by reduction in time spent in hospital. The spacer also helps to allow mobilization by partial weight bearing on a stable femoral component and provide pain control which improves quality of life as compared to prolonged intravenous antimicrobial therapy.

Keywords: Infection, Bone loss, Revision, Hip, Femur, Antibiotics.