|Beitragstitel||Revision by silver coated total femur prosthesis for infected tumoral hip arthroplasty. A case report.|
Management of bone loss in revision arthroplasty is demanding, in particular for after tumor resection. When bone loss does not allow stable stem reimplantation, total femur replacement is an option. We present the case of a two stage-revision for an infected proximal femur megaprosthesis.
A 74 yo female patient was treated in our sarcoma centre by wide resection and reconstruction with a massive total hip arthroplasty for a high grade chondrosarcoma of the proximal femur.
Ten months later, she was re-admitted with severe hip pain and elevated blood inflammatory markers (CRP of 155mg/l and a WBC of 22G/l). Hip aspiration showed methicillin sensitive S. epidermidis. A two stages revision approach was chosen and an antibiotic loaded cement spacer implanted after compete removal of the primary prosthesis. A 4 week interval was decided before reimplantation. Reconstruction with a proximal femur stem was not possible due to the small size of the distal bony segment and poor bone quality. The remaining femur was therefore completely resected and a Megasystem C Por-Ag® (LINK® implants) total femur implanted with a dual mobility cup. Antibiotherapy was maintained for a total of 3 months.
Postoperative follow-up was favorable. The patient was discharged after 2 months. She was partially dependant for ADL.
Revision of tumor megaprostheses is demanding and its incidence will increase in the future. Total femur replacement is a viable option in case of severe bone loss, with a too short residual bone stump for reimplantation of a new stem.
Soft tissues management is a key point in infection prevention and should include early planing of flaps to allow proper wound closure. Silver coated implants represent a new tool to decrease (re-) infection rates but longer follow-up is needed, in particular to monitor the late systemic effects of silver.