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Query: UNIPROT:P50502 (Hip)
 7,003 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A total of 72 patients (73 hips) who had been submitted to Girdlestone arthroplasty to treat aseptic (63%) and septic (37%) loosening of total hip replacement, and who had been followed-up after an average of 6.8 years, were reviewed. Good pain control was obtained in nearly 60% of the patients. Functional results were poor, but 52% of the patients said that they were satisfied. Mean score based on the Harris Hip Score was 54. Infection was dominated in 92.6% of the cases. The best results were obtained in younger patients, while we did not observe any differences based on the cause of loosening (aseptic or septic). Despite the limits of the method, Girdlestone arthroplasty continues to constitute an effective indication for the treatment of loosening in total hip replacement, when the choice of reimplantation exposes the patient to a high risk of further failure.
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PMID:Girdlestone arthroplasty for loosening of the total hip prosthesis: evaluation and results. 868 78

Infection is a devastating complication after total-hip arthroplasty. Between June 1991 and December 2001, 42 patients were treated at our center for chronically infected total-hip arthroplasty using a 2-stage articulating antibiotic hip spacer technique. Of the 27 patients available for review, 26 (94%) remain clinically free of infection at an average 76 months (range, 28-148 months) postoperatively. Twenty-two (81%) patients had a positive identification of the infecting organism. All patients received a minimum of 6 weeks of intravenous antibiotics and the Harris Hip Scores improved from 53 (range, 36-68) to 92 (range, 81-99) postoperatively. Advantages of this technique include improved patient function, maintenance of bone stock and soft tissue tension, thus simplifying reimplantation.
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PMID:Ten-year experience using an articulating antibiotic cement hip spacer for the treatment of chronically infected total hip. 1623 Feb 38

We report a rare case of posterior hip dislocation after a low energy trauma. The patient sustained a trochanteric fracture in the same hip six months ago, which was fixed using a sliding hip screw and had healed. At surgery a deep wound infection was found and a methicillin-resistant Staphylococcus epidermidis (MRSE) was cultured. After thorough debridement, an excisional arthroplasty was decided. The patient received specific intravenous antibiotics and after six weeks a total hip arthroplasty was done. In three years follow-up the patients presented with a fully functional hip without any signs of infection. Hip dislocation after a trochanteric fracture internal fixation is rare complication associated with high morbidity and mortality. Infection eradication and a second stage arthroplasty can be life and limb saving.
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PMID:Deep wound infection after a trochanteric fracture internal fixation presenting with hip dislocation: a case report. 2018 Sep 52

Two-stage revision hip arthroplasty for infection using an antibiotic-loaded cement spacer has been used frequently with good results. However, spacer instability is also frequent. Proximal cementation of the spacer could avoid spacer dislocation. We retrospectively assessed 35 patients in whom a 2-stage revision hip arthroplasty for infection was carried out using an antibiotic-loaded cement spacer with gentamicin (Spacer-G) in which the spacer was proximally cemented in 16 patients. The mean follow-up was 32 months. We assessed spacer stability and infection elimination. There were 8 spacer dislocations (22.9%), 5 in hips without proximal cementation and 2 in hips with proximal cementation (p>0.05). There was no fracture in any hip. Reinfection occurred in 5 hips (14.3%), in 3 with the same microorganism, while 2 had a different microorganism. Our results indicate that the proximal cementation of the spacer prevents its dislocation. Infection was eliminated in 86% of the hips.
Hip Int 2010
PMID:Two-stage revision of hip prosthesis infection using a hip spacer with stabilising proximal cementation. 2051 84

To evaluate the safety of using extended trochanteric osteotomy (ETO) in a 2-stage revision of periprosthetic hip infection, we performed a retrospective review of 23 patients using ETO in the revision of infected hip arthroplasty and compared them to 46 patients using ETO in the revision of noninfected hip arthroplasty. Harris Hip Score improved from 36 points preoperatively to 82 points postoperatively. Infection was eradicated in 22 patients (96%). ETO healed in all at a mean of 10.6 weeks. No stem was revised for aseptic loosening. Complications included 2 periprosthetic fractures, 1 peroneal nerve palsy, and 1 dislocation. Postoperative Harris Hip Score, ETO union rate, time to healing of ETO, stem stability, and complication rate did not differ between the 2 groups. Our data suggest that ETO can be safely used in treating periprosthetic hip infection.
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PMID:Is extended trochanteric osteotomy safe for use in 2-stage revision of periprosthetic hip infection? 2149 84

Infection is becoming the most important as well as the most devastating mechanism of prosthetic joint failure. The incidence is increasing because the absolute number of patients operated is increasing and because more often very sick, debilitated and immunocompromised patients are operated. The trend reveals a further increase in the years to come. Diagnosis may be very easy in case of high grade processes, but also extremely difficult in some other instances. Misdiagnosing infection leads to repeated early failures that are distressing for patients as well as surgeons. To avoid failures related to misdiagnosed prosthetic joint infections a step-wise algorithm of action is proposed and the diagnostic strength of the steps discussed. The key point is to select potential candidates to define the probability of an ongoing infection and then to select the tools to strengthen the suspicion. Further procedures are based on the analysis of the pseudo-synovial fluid obtained by aspiration. Diagnostic conclusions form the basis for treatment decisions.
Hip Int
PMID:The diagnostic protocol for evaluation of periprosthetic joint infection. 2295 69

Recent advances in chemotherapy and radiation therapy in the treatment of malignant bone tumours as well as the consistent increase of revision arthroplasties have been followed by an increased use of megaprostheses. These large foreign bodies make infection a common and feared complication. Infection rates of 3 - 31% have been reported (average approx. 15%), often in conjunction with risk factors, e.g. the anatomic region (pelvis implants in particular), implant alloy, and underlying reason for implantation of a megaprosthesis. Apart from the basic principles of septic revision arthroplasty, special patient and implant factors have to be considered in infected megaprosthesis, which we have summarised in our paper (e.g. life expectancy, implant design, spacers and external stabilisation). This article further analyses the current literature available for these cases and summarises outcome after treatment of periprosthetic infections.
Hip Int
PMID:Incidence and outcome after infection of megaprostheses. 2295 77

Infection of a total hip replacement (THR) is considered one of the most serious complications in orthopaedic surgery. Problems derive from the presence of biofilms with inherent resistance to usual antibiotic treatment and bone defects resulting from infection induced osteolysis. Discussions on the choice of treatment mainly focus on the chance of eradicating the infection in either one or more stages. The advantages of only one operation with regard to patients' satisfaction, functional results and economical burden are evident. However, the fear of re-infection usually leads surgeons to multiple stage procedures, mostly using antibiotic loaded spacers in the interval. Spacers have no effect on biofilms and are associated with a high rate of complications such as breakage or dislocation. Cemented revisions show several disadvantages like reduction of biomechanical properties through added antibiotics, inferior long term results, difficulties of removal in case of recurrence etc. Uncemented implants appear more advantageous but are at risk of becoming colonised by remaining biofilm fragments. To overcome this risk higher local concentrations of antibiotics are needed. Allograft bone may be impregnated with high loads of antibiotics using special incubation techniques, resulting in an antibiotic bone compound (ABC). ABC provides local concentrations exceeding those of cement by more than a 100-fold and efficient release is prolonged for several weeks. At the same time it is likely to restore bone stock, which is usually compromised after removal of an infected endoprosthesis. Based on these considerations new protocols for one-stage exchange of infected THR have been established. Bone voids may be filled with ABC, uncemented implants may be fixed in original healthy bone. Recent studies indicate an overall success rate of more than 90% with one operation, without any adverse side effects. Incorporation of allografts appears as after grafting with unimpregnated bone grafts. One stage revision using ABC together with uncemented implants, should be at least comparable to multiple stage procedures, but with the advantage of the obvious benefits for patients and cost.
Hip Int
PMID:Bone grafting and one-stage revision of THR - biological reconstruction and effective antimicrobial treatment using antibiotic impregnated allograft bone. 2295 85

Two-stage total hip arthroplasty (THA) is considered a safe choice for the treatment of primary infectious arthritis of the hip. In cases where the proximal portion of the femur is intact without infection, the use of a spacer with a femoral stem during the interim would disturb the normal femoral medullary cavity. The authors report the technical procedure and outcomes of cases using a novel medullary sparing, antibiotic-loaded hip spacer for the treatment of hip infections.Five consecutive patients (5 hips) with infectious arthritis of the hip were treated in a 2-stage approach using an intraoperatively made medullary-sparing hip spacer. During the first-stage THA, after thorough debridement of potentially infected and necrotic soft tissues, the spacer was inserted into the femoral neck and fixed without opening the femoral canal. Antibiotics were administered for at least 6 weeks and were continued until the infection was controlled clinically, after which the second-stage THA was completed.Infection was eradicated in all 5 hips. Average follow-up was 39.6 months (range, 30-59 months). At most recent follow-up, no recurrence of infection was observed. No specific complications were associated with the use of this novel spacer. Average Harris Hip Score improved from 35.2 (range, 28-43) before the first-stage THA to 61.6 (range, 54-71) between the 2 stages and to 93.6 (range, 89-99) at final follow-up. All patients ambulated with the aid of crutches during the interim period.
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PMID:Novel articulating medullary-sparing spacer for the treatment of infectious hip arthritis. 2359 Jul 77

Infection is a devastating complication of total hip arthroplasty (THA). Risk factors have been recognised and prevention is possible. The nature of the disease is heterogeneous and for satisfactory management one has to weigh factors related to pathogen, host, local soft tissue, bone stock, surgeon experience and financial resources. Available data in the current literature is of poor quality and there is a lack of data comparing different techniques. Referral of patients to dedicated departments with the appropriate facilities may be more appropriate.
Hip Int 2014 Oct 02
PMID:Management strategies for infected total hip arthroplasty. A critical appreciation of problems and techniques. 2532 80


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