Intraoperative synovial C-reactive protein is as useful as frozen section to detect periprosthetic hip infection.

Background: Synovial quantification of C-reactive protein (SCRP) has been recently published with high sensitivity and specificity in the diagnosis of periprosthetic joint infection. However, to our knowledge, no studies have compared the use of this test with intraoperative frozen section, which is considered by many to be the best intraoperative test now available.

Questions/purposes: We asked whether intraoperative SCRP could lead to comparable sensitivity, specificity, and predictive values as intraoperative frozen section in revision total hip arthroplasty.

Bone grafting and two-stage revision total hip arthroplasty.

Periprosthetic deep infection in combination with substantial bone loss is one of the most challenging situations in revision hip surgery. We believe the effective management of these patients requires infection control as well as bone reconstruction. A review of our previously published studies on antibiotic loaded bone allografts is presented in this paper.

High failure rate with the GAP II ring and impacted allograft bone in severe acetabular defects.

Background: Reconstruction rings and bone allografts have been proposed to manage severe acetabular bone loss. However, a high early failure rate of the Graft Augmentation Prosthesis (GAP) II reinforcement ring (Stryker Orthopaedics, Mahwah, NJ, USA) has been reported in one small series.

Questions/purposes: We therefore determined (1) the survival of this device in combination with impacted morselized allograft bone in patients with severe defects and (2) the complication rate.

The use of femoral struts and impacted cancellous bone allograft in patients with severe femoral bone loss who undergo revision total hip replacement: a three- to nine-year follow-up.

We determined the midterm survival, incidence of peri-prosthetic fracture and the enhancement of the width of the femur when combining struts and impacted bone allografts in 24 patients (25 hips) with severe femoral bone loss who underwent revision hip surgery. The pre-operative diagnosis was aseptic loosening in 16 hips, second-stage reconstruction in seven, peri-prosthetic fracture in one and stem fracture in one hip. A total of 14 hips presented with an Endoklinik grade 4 defect and 11 hips a grade 3 defect.

Incidence of deep infection in aseptic revision THA using vancomycin-impregnated impacted bone allograft.

The addition of antibiotic to cement is a frequent practice in aseptic revision hip surgery There is concern about adding vancomycin to cement due to potential effects on mechanical properties and prolonged elution of subtherapeutic levels antibiotic. Bone allografts can store and provide high levels of vancomycin to surrounding tissues. We analyzed the incidence of infection after one-stage aseptic revision hip reconstruction utilizing acetabular and/or femoral vancomycin-impregnated impacted bone allograft and a THA fixed with cement containing no antibiotic.

Combining C-reactive protein and interleukin-6 may be useful to detect periprosthetic hip infection.

Background: The sensitivity and specificity to detect periprosthetic infection of the different methods have been questioned, and no single laboratory test accurately detects infection before revision arthroplasty.

Questions/purposes: We asked whether preoperative C-reactive protein (CRP) and interleukin-6 (IL-6) could lead to similar sensitivity, specificity, and predictive values as our previous results obtained with intraoperative frozen section (FS) in revision total hip arthroplasty (THA).

Methods: We prospectively followed 69 patients who had undergone revision THA for failure of a primary THA.

Impacted bone allografts and a cemented stem after failure of an uncemented stem: preliminary results.

We reviewed the results of impaction bone grafting technique and a cemented stem in 27 consecutive patients with a failed uncemented femoral component. At an average follow-up of 55 months (25 to 94) none of the femoral components were removed or revised because of aseptic loosening or deep infection. In one hip a non progressive radiolucent line was observed in Gruen zone 5 with no clinical evidence of failure.

Proximal femoral reconstructions with bone impaction grafting and metal mesh.

Extensive circumferential proximal cortical bone loss is considered by some a contraindication for impaction bone grafting in the femur. We asked whether reconstruction with a circumferential metal mesh, impacted bone allografts, and a cemented stem would lead to acceptable survival in these patients. We retrospectively reviewed 14 patients (15 hips) with severe proximal femoral bone defects (average, 12 cm long; 14 type IV and one type IIIB using the classification of Della Valle and Paprosky) reconstructed with this method.

Acetabular revision with metal mesh, impaction bone grafting, and a cemented cup.

Unlabelled: Impaction grafting is controversial in the presence of segmental and cavitary acetabular defects and requires the use of supplemental devices to close segmental defects. This approach, however, would allow treating combined deficiencies that could not be managed with impacted cancellous bone alone. We raised the following two questions: (1) What is the survival rate in patients with combined deficiencies reconstructed with metal mesh, impaction grafting and a cemented cup and (2) can metal mesh prevent cup migration? We evaluated 23 cavitary uncontained acetabular defects in revision hip arthroplasty.

Viability of impacted bone allografts under metal mesh at the calcar in revision surgery of the hip.

Metal meshes are used in revision surgery of the hip to contain impacted bone grafts in cases with cortical or calcar defects in order to provide rotational stability to the stem. However, the viability of bone allografts under these metal meshes has been uncertain. We describe the histological appearances of biopsies obtained from impacted bone allografts to the calcar contained by a metal mesh in two femoral reconstructions which needed further surgery at 24 and 33 months after the revision procedure.

Locking compression plate fixation of Vancouver type-B1 periprosthetic femoral fractures.

Background: Fractures occurring at or near the distal tip of a hip prosthesis with a stable femoral stem (Vancouver type-B fractures) are associated with many complications because of the inherently unstable fracture pattern. Locking compression plates use screws that lock into the plate allowing multiple points of unicortical fixation. Such unicortical fixation may lower the risk of damage to the cement mantle or a stable femoral stem during the treatment of a periprosthetic femoral fracture.

Nodular skin metastasis mimicking infection in a revision total hip arthroplasty scar.

We present the case of a 60-year-old man who had metastasis of a nodular squamous cell carcinoma from a laryngeal carcinoma that mimicked an infected sinus in a 4-month postoperative revision total hip arthroplasty scar. A diagnosis was made at the time of frozen section. The patient died 3 months after tumor resection as a result of multiorgan failure.

Vancomycin-supplemented cancellous bone allografts in hip revision surgery.

We explored the role of vancomycin-supplemented cancellous bone allografts in hip revision surgery. We evaluated the incorporation of these allografts in 18 pigs' radiographs, histology, and immunohistochemistry. High-quality radiographs, histologic examination, and immunologic expression of metalloproteinase-13 and transforming growth factor-beta 2 indicated vancomycin did not considerably affect bone graft incorporation.