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.
Ideberg type III glenoid fractures with associated superior shoulder suspensory complex (SSSC) injuries are rare, and related treatments have not been reported in the literature. The purpose of this study was to evaluate the clinical outcomes of such injuries treated with open reduction and internal fixation (ORIF). Between July 2007 and April 2012, ten patients with Ideberg type III glenoid fractures were surgically treated using ORIF with 2 cannulated screws or a screw combined with a metacarpal plate through an anterior approach. Patients with associated SSSC injuries underwent ORIF with K-wires or plates. Information was available for 9 patients with a mean follow-up of 24.1±18.2 months. Mean bone-healing time was 8.4±2.2 weeks. At last follow-up, mean forward flexion of the operative shoulder was 157.8°±7.5°, mean external rotation was 62.9°±7.9°, and mean internal rotation was thoracic level T6±0.8. Mean Constant score was 84.1±3.7 points, which was a mean of 92.7%±3.4% of that seen in the contralateral shoulder. Mean UCLA score and Disabilities of the Arm, Shoulder and Hand score were 33.6±1.7 and 16.6±7.7, respectively. The results show that Ideberg type III glenoid fractures with associated SSSC injuries can be successfully treated using ORIF through an anterior approach. Glenoid fractures and SCCC injuries should be treated simultaneously.
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