Cephalomedullary Nail as a Definitive Antibiotic Spacer for Multidrug Resistant Periprosthetic Infection of a Proximal Femoral Endoprosthesis

Abstract

Introduction: Periprosthetic hip infections in the setting of massive proximal femoral bone loss pose a complex challenge to both patients and arthroplasty surgeons alike. As these patients are often multiply revised and can be infected with multidrug resistant organisms, the likelihood for a successful outcome with the gold-standard 2-stage revision is significantly diminished, and definitive management is often achieved with amputation or an antibiotic eluting cement spacer. With reduced bone stock and poor soft tissue tension, creation of such a spacer to not only provide local drug delivery, but also achieve length, stability, and confer some degree of mobility to these patients is technically demanding, and has been fraught with mechanical complications in recent literature. Materials and Methods: The purpose of this article is to report on a novel technique for definitive management of prosthetic joint infection in the setting of massive proximal femoral bone loss. This is a case of a 61-year-old medically complex patient with an infected proximal femoral endoprosthesis colonized with multidrug resistant bacteria, treated with creation of a novel articulating antibiotic eluting massive proximal femoral cement spacer with a cephalomedullary nail as definitive management. Results: In our patient we have had successful suppression of his life-threatening infection and enabled partial weight bearing on the affected extremity at 1 year postoperatively. Conclusion: Articulating antibiotic eluting cement proximal femoral spacer with a cephalomedullary nail is a viable surgical option for definitive management of prosthetic joint infection in the setting of massive proximal femoral bone loss.